CQM Coordinator

Job Family Summary:

Revenue Operations is characterized by consistency of actions, values, methods, measures, principles, expectations, and outcomes. It comprises of capacity management, production planning, timely reporting, and timely submission to the insurance companies with coordination with the revenue integrity.

Role Summary:

The CQM Coordinator role is responsible for engaging team members in the claims process. Identify network issues and communicate with IT to resolve those. Co-ordinate with team members to achieve the organization's goals.

Primary Responsibilities:

1. Allocation of claims to the team members, ensuring claims are allocated to each team member.
2. Report back to line managers/onsite managers on any type of claims process issues that may affect the process.
3. Meet the team regularly to discuss challenges in the claims process.
4. Escalate IT on network issues, track those, and keep in a shared folder to share with management.
5. Monitor CQM process within given TAT with the provider as well as the end user.
6. Gather relevant information to clearly describe and properly escalate issues to supervisors and managers.
7. Ensure high-quality customer service and respect medical and work ethics at all times while conducting daily tasks.
8. Ensure that business decisions and processes are documented professionally and that communication requirements are adhered to in a timely and professional manner.
9. Provide all the needed support as advised by the supervisor based on the business need.
10. Other related tasks assigned by the line manager.

Desired Candidate Profile:

1. Bachelor's Degree or PG in Medical, paramedical, or any life science.
2. Most relevant coding certification with updated membership to a body accepted by the geographical governance area (CPC, COC, CIC, CPMA, CCS, etc.).
3. Relevant experience of at least 2 years in claims process.
4. Good IT skills.
5. Good knowledge of ICD's, CPT's & coding guidelines.

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