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MedRisk LLC

QA Auditor Level I

MedRisk LLC Conshohocken, Pennsylvania, United States

Hospitals and Health Care · 1,001-5,000 employees

Oct 06
qa Junior (0-2 yrs) Full-time United States
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About the role

The QA Auditor is responsible for auditing critical fields on provider bills against re-priced EOBs to ensure accuracy and compliance. They also identify systematic error trends and provide feedback to internal teams to support continuous improvement.

What they look for

Quality Assurance Workers Compensation Billing CPT Coding ICD-10 HCPC Data Auditing Time Management Organizational Skills Problem-solving Microsoft Office HIPAA Compliance Multi-tasking Communication Training Attention to Detail

Requirements

Candidates should have strong organizational and problem-solving abilities with proficiency in MS Office products. Extensive knowledge of Workers Compensation billing procedures, including CPT, ICD-10, and HCPC coding, is preferred.

Full description

***This position will be in our Conshohocken, PA office 5 days a week, hours 9:00 am to 5:00 pm.***

***Only candidates in the Philadelphia area local to Conshohocken, PA will be considered ***

Position Summary

  • The QA Team audits critical fields on all provider HCFAs & UBs against re-priced MedRisk Generated EOBs or MedRisk Generated HCFAS before mailing.
  • Trends are observed, identifying key systematic issues.
  • QA team offers above standard quality on all bills before mailed.
  • Confirming accuracy of billing data, routinely interacts with medata application for re-pricing incorrect bills.

Primary Duties & Responsibilities

  • Audit all Workers Compensation bills re-priced through “Medata or Bridge”.
  • Meet/exceed audit productivity and quality standards to maintain the integrity of the claim/bill.
  • Maintain and report individual and team claim/bill backlogs, ensuring that all claims are QA’d within printed receive dates, audited within objective 2 days TAT goal.
  • Determine error sources and accurate entry of claim audits, document with accuracy in QA Printing Production Excel log kept on Folks2 drive
  • Interpret and understand MedRisk carrier contracts “CQ” and basic knowledge of state guidelines compliance, and HIPPA regulations.
  • Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to Quality Assurance and CDT teams.
  • Provide one-on-one training as needed with associates and actively participate in Quality Assurance Team meetings.
  • Perform focused audits, working with varying types of data.
  • Complete other clerical or support duties as assigned.
  • Lead by example, demonstrate good promptness and adhere to company policies for yearly attendance.

Qualifications

  • Detail-oriented with strong organizational, time management and problem-solving abilities.
  • Preferred extensive knowledge of general Workers Compensation billing procedures including knowledge of CPT Coding, ICD-10, and HCPC
  • Strong organizational, time management and project management skills with multi-tasking abilities.
  • Manage multiple priorities, maintain confidentiality, and display a courteous, patient, and helpful attitude toward employees.
  • Basic understanding of HIPPA policies and procedures.
  • Ability to multi-task, adapt quickly to change and follow projects through completion
  • MS Office Products; Word, Excel and Outlook experience

Competencies (choose at least 4)

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