Quality Review Analyst -REMOTE

* Position is eligible for Remote / Work from Home opportunity *

Department: Part B and DME Med Review

Telecommuting Eligible: Yes

Job Grade: N13

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Job Title

Quality Review Analyst

Job Summary

The Quality Review Analyst is responsible for the accurate and timely review of the Medicare workload and ensures consistency and quality administration of the Centers for Medicare &amp Medicaid Services (CMS) regulations. This position communicates in a professional manner while maintaining a high level of confidentiality and provides feedback to front line staff in a respectful and considerate manner about issues that may arise.

Key Performance Indicators

• Analytical ability and attention to details
• Ability to maintain confidentiality
• Excellent customer service

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Performs timely and accurate quality assurance reviews of critical work tasks completed by staff
• Acquires a detailed working knowledge of Medicare and organization regulations, policies, team functions and procedures, medical terminology, Claims Processing Timeliness (CPT), and ICD-9 coding and Medicare bulletins
• Monitors and reports quality review statistics
• Pays close attention to the details of all work and strives for a high level of accuracy
• Applies critical thinking, analysis, and evaluation always giving due consideration to the evidence, the context of judgement, relevant criteria, and nature of the problem or question at hand to make accurate and timely decisions
• Ability to work multiple workloads during the day
• Ability to review, analyze, and complete special projects as needed
• Remains objective when inconsistencies or irregularities are identified within work
• Adapts routine processes accordingly to achieve favorable results
• Builds constructive working relationship with clients/customers, other work units, and other individuals to meet mutual goals and objectives
• Contributes positively to a team-based work environment

Non-Essential Duties and Functions

• Other duties as assigned

Minimum Qualifications

• High school diploma or GED
• 1-year Medicare experience
• Accurate data entry skills
• Demonstrated problem solving skills
• Ability to provide and receive constructive feedback

Preferred Qualifications

• Above requirements and the following:
• Excellent communication skills

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statemen t

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Below is the salary range for potential new hires.

Salary Range: $17.20 – $27.25

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 04/12/2024 at 8:00AM CST. No further applications will be considered.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)