Senior Quality Analyst
Current• Collaborated with 20+ agents to support production quality checks for pre-authorization, eligibility verification, and ATS.• Rectified errors within 24 hours TAT and shared feedback with users about opportunities found in the cases.• Discussion of Key Result Area(KRA) about target, leave, performance, Rebuttal of Error and rating P3MS for specific Auditor.• Scheduled quality meets twice a month to summarize the RCA of errors and to discuss client updates• Reviewed chart documentation to ensure patients met medical policy guidelines.• Prioritized incoming authorization requests according to urgency.• Obtained authorization via portals or phone and followed up regularly on pending cases.• Maintained individual payor files to include up-to-date requirements needed to successfully obtain authorizations.• Reinitiated appeals for denied authorizations.• Responded to clinical questions regarding payer medical policy guidelines.• Confirmed accuracy of CPT and ICD-10 diagnoses in the procedure order.• Demonstrated proficiency in client software like eRAD, Athena, and Centrecity.• Consolidation of Auditors Daily Audit Report on daily Basis and maintaining track of target daily met or not.• Conducted eligibility verification to check whether users had mentioned proper benefits like effective date, plan name, deductible, Out Of Pocket and its remaining, copay, and co-insurance.• Ensured availability of clinical in client software required for approval of procedure.• Scheduled procedures to patient profiles with CPT like CT, MRI, diagnostic X-Ray, PET scan, and ICD-10 recommended by hospital visit notes.