Billing Quality Or Audit Representative

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function are responsible for all aspects of quality assurance within the Billing job family. Conducts audits and analysis and provides feedback to reduce errors and improve processes, design, and performance.

Primary Responsibilities

• Extensive work experience within own function
• Work is frequently completed without established procedures
• Works independently
• May act as a resource for others
• May coordinate others activities
• Quality review for Front end RCM processes. es
• Communicates with leadership for training when a knowledge gap is identified
• Acts upon leadership feedback of issues identified and develops action plan for solutions
• Supports QA solutions that serve the needs of operations in understanding review results and actions taken to resolve gaps in the process
• Effective in using relevant computer systems and software (EQT, Reporting Systems, OLC, operations systems, MS Office)
• Utilizes critical thinking skills to solve issues.
• Collaborates with internal stakeholders with RCA findings and trends in process gaps to improve processes with the help of CAPA methods.
• Performs Quality reviews to validate process accuracy and input findings into EQT
• Logs daily productivity into EQT
• Communicates issues/gaps identified while performing daily activities
• Completes other tasks as assigned
• Solves moderately complex issues
• Actively participates in meetings
• Practices standard operating procedures, policies, and process knowledge of how they impact the business and operations
• Uses QA methodology when participating on projects that will improve the overall process for the department and operations
• Works with leader on potential solutions when issues are identified during QA review process
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
  
  

• Any course or Equivalent experience
• College Graduate/ Highschool Graduate/ SHS Graduate
• 2+ years of experience in a role supporting a quality assurance function or related operational function within Revenue Cycle Management
• Intermediate MS Office experiences including Word, Excel, and PowerPoint
• Experience in effective communications (verbal, written, and presentation) skills with the ability to communicate to a variety of management levels within the organization including leadership Analytical skills that will lead to aiding in process improvements within the department and operations
• Knowledge in Revenue Cycle Management (US Healthcare RCM)
• Demonstrates an understanding of the organizations operations, products and applications, strategies, processes, and/or business priorities for effective outcomes
• Proven ability to work independently and collaborate with team members across teams and departments.
• Proven to possess solid written and verbal communication skills
• Amenable to work full onsite set up (Alabang, Quezon City & Makati City)
  
  

• Experience in large, multi-function and cross geographic organization
• Specific experience working in an Operations Environment Technical Tools: Understands relevant computer systems and software (i.e., Reporting Systems, Operations systems, MS Office)