- For Medical Management College/ University degree holder.
- For NA High School/Equiv, Associates Degree preferred or equiv work experience.
- • Focus on enabling quality deliverables and enhancing customer satisfaction.
- • Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
- • Interact with customers (internal / external) to meet process deliverables.
- • Manage and resolve escalations and issues raised by customers.
- • Single point of contact for all knowledge related issues.
- • Data accuracy with respect to client requirements.
- • All required data to complete the provider database or provider profile needs to be captured with 100% accuracy in the client applications.
- • Need to work on complex state mandate applications, where the timelines are very stringent.
- • Minimize rework by developing First Time Right culture.
- • Generate process improvement ideas for better productivity, accuracy & turnaround time.
- • Participate as potential seed resources for staffing new engagements.
- • Perform root cause analysis on the errors made by the team members.
- • Handles Supervisor Calls and escalation calls.
- • Check and update all missing information from the requests as required by customer/client.
- • Monitor product updates and communicate product inquiries with the client.
- • Report performance dashboards on a periodic basis to the customer stakeholders.
- • Engage with Customer and drive status report meetings.
- • Effectively communicate information on products/services or trouble shoot issues within the specified time frames as agreed upon with the client,.
- • In a manner that is understandable by the end user/ customer.
- • Connect with the customer & provide highest level of customer satisfaction.
- • Perform transactions as per defined guidelines.
- • Resolve process related queries within defined timelines.
- • Provide periodic status reports to the team leader on performance, status and any escalations.
- • Adhere to defined support and quality processes as per the guidelines.
- • Maintain proper documentation of all the transactions.
- • Perform quality assurance review wherever applicable basis the process requirement.
- • Assist with audits and maintain strict level of confidentiality on all matters pertaining to provider and /or payers.
- • Prepare professional communication, emails, letters to providers.
- • Meet deadlines and ensure good follow in call and email tracking.
- • Ensure that quality, efficiency and productivity standards and targets are met.
- • Review productivity with each associate and recommends followup training if necessary.
- • Analyze areas for improvement with an objective to meet program metrics.
- • Report regular error feedback.
- • Performs other duties as may be assigned.
- • Focus on enabling quality deliverables and enhancing customer satisfaction.
- • Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
- • Participate as potential seed resources for staffing new engagements.
- • Perform root cause analysis on the errors made by the team members.
- • Minimize rework by developing First Time Right culture.
- • Identify knowledge gaps and provides inputs to the training teams.
- • Act as Internal Auditor for the process auditing the domainspecific metric.
- • Take Initiatives to improve quality rankings and completing assignments on time.
- • Respond to queries raised by the team and provide appropriate feedbacks.
- • Participate in project and organization initiatives led by the Delivery leadership.
- • Contribute new ideas and innovative approaches at work.
- • Assist the associates in performing their tasks as per client, state and/or federal protocols as well as other related guidelines.
- • Ensures that associates are informed and updated on changes in state rules, regulations and client protocols.
- • Under the direction Team Lead/Team Manager, act as a resource person for specific regulations and protocols, to properly address issues and concerns on medical review process.
- • Act as frontline in providing product updates and answering process related questions from process executives and senior process executives.
- • Take charge of the operations in the absence Team Lead / Team Manager.
- • Maintain acceptable levels of performance including but not limited to attendance, adherence, customer courtesy, and all other productivity and efficiency targets and objective.
- • Monitor compliance of associates to established federal, state, URAC, client and protocols.
- • Keep track of turnaround time of specific state reviews and coordinates with the process executives and senior process executives to facilitate release of medical review assessments on time.
- • Report to the Team Lead/ Supervisor/ Manager on state review statistics, issues encountered complaints, etc and escalate unresolved issues as appropriate.
- • Oversee the work of new hires and continuous coaching of the program's staff with the assistance of the Team Lead.
- • Complete a QC report and coach Nurse Reviewer/s regarding corrections and/or suggestions made in their review.
- • Work closely with the Program Trainer in establishing and maintaining Program Manuals.
- • Active participation in the process/knowledge transitions from business to Cognizant center.
- • Successful client certification as Process trainer (offshore) and subsequent Offshore knowledge transfer.
- • Responsible for review and updation of domain specifics SPOC for all queries before it is put forward to the client and create a repository of FAQs.
- • Ensure any updates in state mandates, policy & procedures would reach the operations team in a timely fashion.
- • Assist associates in processing tricky and high value transactions.
- • Deliver and validate clientspecific metric deliverables.
- • Responsible for claims adjudicated in a day.
- • Adjudication of claims with zero critical errors Responsible for assisting with online research projects for claim and litigation matters.
- • Responsible for preparing litigation files for archiving.
- • Responsible for assisting with collections This includes payment processing, record keeping, correspondence composition, and damage invoice composition.
- • Work effectively in team environment to coordinate all credentialing processes (ie Third party verification groups wherever applicable basis the process requirement).
- • Support the floor on queries related to complex Benefit plans and Benefit plan analysis.
- • Lead the daily huddle related to knowledge management.
- • Advice and counsel employees on benefit related issues in accordance with the Certified and classified Master Agreements and Administrative Program enabling proper and complete utilization of existing and new benefits.
- • Continuous contribution to process excellence/improvement.
- • Perform task estimation.
- guide the service analyst on estimation.
- '
• Perform quality assurance review on completed credentialing files. - • Responsible for the inventory of the respective hospital accounts and deliver the SLA parameters.
- • Responsible for the agents working in the respective hospital accounts.
- • Develop Provider Directory with accurate details of providers.
- • Collect and verify all demographic information from the provider through different sources as deemed appropriate.
- • Verify all education & hospital affiliations information of the providers.
- • Receive and process provider database on a regular basis.
- • Tracks progress of outstanding verifications from Schools and Hospitals.
- • Works effectively in.
- Billing
- Revenue Cycle Management
- Payment Posting
-
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Analyst - Quality - Hyderabad, India - Cognizant
Description
Not Applicable
Qualification:
Graduate (exclusion:
BE/BTech/MCAResponsibility:
'Business / Customer:
Data Processes:
For NA, Claims, RCM, Provider Services and Member Services:
For Claims, RCM and Provider Services:
For Medical Management and Provider Services:
• Query Management:
For NA:
Voice Processes:
For Claims, RCM and Member Services:
Project / Process:
Data Processes:
:
For Medical Management:
For Claims:
For RCM:
Must Have Skills
Good To Have Skills