PHRN Quality Analyst
Full-time
Omega Healthcare Management Services, Inc.
- Prioritize incoming authorization and referral requests according to queue urgency
- Review patient’s clinical and chart documentation related to the service submitted by the provider’s office
- Obtain and/or follow up on authorization and referral requests from the patient’s payer/s through any of the following methods—depending on the payer’s policy:
- Perform outbound calls to payer’s authorization department
- Access payer’s authorization online portal
- Submit faxes to payer’s authorization department
- Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests
- Obtain and/or follow up payer’s peer-to-peer review requirements and send them back to provider’s office for the actual initiation
- Cater inbound calls from payers and perform necessary actions required for the task
- Listen and review voicemail messages from payers then perform necessary actions required for the task
- Monitor activities of Nurses to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management.
- Provide basic on-the-job training for direct reports and serve as a resource to address questions related to the policies, processes and procedures.
- Delivers required number of QA Monitors on a timely manner
- Provide quality metric analysis on compliance scores
- Participates in call calibration to understand and identify targets
- Generates and trends daily/weekly/monthly QA related reports
- Performs side-by-side sessions and provide real-time feedback
- Skilled in pinpointing root cause/s for performance variance
- Provide recommended intervention activities to address quality metric opportunities identified
- Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
- Comprehensive understanding of Medical Terminology
- Prior experience in processing multispecialty authorizations including contact with payers
- Experience in prior authorization process
- Experience with general computer software (Internet, Word, Outlook, PDF required)
- Proficiency to learn new software programs quickly
- Excellent customer service skills: communicates clearly and effectively
- Excellent verbal and written communication skills
- Professional and effective interaction skills with co-workers, clients, providers, and vendors
- Proven ability to work well individually and as a team member
- Strong attention to detail
- Ability to follow company and account-specific standard operating procedures and policies
- Ability to adapt to constantly changing environment
- Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
- Ability to remain organized with multiple interruptions
- Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
- Ability to comfortably receive constructive feedback
- Graduate of Bachelor of Science in Nursing with active PH registered nurse license
- 1 year of experience of US healthcare authorization business
- At least 2 years of experience in the BPO/Healthcare industry is an advantage
- Bachelor's Degree in Nursing with active PH Registered Nurse license
- Minimum 2 years of Quality Analyst experience in a US Healthcare account (Prior Authorization or Claims/Denial/Appeal)
- Excellent Leadership & Interpersonal relationship
- Strong Process Management & planning skills
- Embrace change and think operationally to achieve business goals
- Proven process improvement experience
Required Skills
Requirements
Vacancy posted 21 days ago
Similar jobs that could be interesting for youBased on the PHRN Quality Analyst in Pasig vacancy
- ...Lead and mentor the PHRN team to ensure high standards of quality in operations. Oversee quality assurance processes and implement improvements based on findings. Work collaboratively with account management and customer service teams to enhance client relations...
- ...The Quality Assurance Analyst is responsible for ensuring that the products and services provided by the company meet the required quality standards. This individual will play a critical role in testing software applications, identifying defects, and suggesting improvements...
- ...We are looking for a Quality Analyst (QA) to join our growing BPO team in Pasig City . This role is responsible for ensuring consistent service quality across customer interactions and supporting continuous improvement of agent performance. What You’ll Do Monitor...
- ...Design Quality Analyst Role and responsibilities • Understands the brief and design requirements from clients / stakeholders • Ensures accuracy of design output based on standards of quality and excellence • Artworks / proofs-to-edit / proofreads design materials...
- ...looking for a highly creative and detail-oriented Graphic Designer / Print Production Artist who can transform client briefs into high-quality visual materials while ensuring accuracy, consistency, and timely delivery. The ideal candidate has strong experience in print...
- ...emergency response, education, health, livelihoods, and climate resilience. We are looking for a skilled PeopleSoft Quality Assurance Analyst to join our team. In this role, you will play a critical part in ensuring the reliability and performance of our PeopleSoft...
- ...We are seeking a detail-oriented and proactive Quality Assurance Specialist to join our team. In this role, you will be responsible for evaluating and assessing the quality performance of call interactions between our team and existing or potential customers. You will...
- ...As a Quality Assurance Specialist , you will be required to take calls, become familiar with account-specific processes, and monitor... ...team and improve overall service quality. At least 1-2 years experience as a quality analyst. At least High school graduate...
- ...Analyze customer interactions to assess quality and adherence to standards. Provide feedback and guidance to team members for performance improvement. Prepare and present quality reports to management. Identify trends and suggest corrective actions to enhance...
- ...live in dignity and security. About the Role We are looking for a detail-oriented and highly analytical HR Systems Quality Assurance Analyst to join our People & Culture team. This role is critical in ensuring the performance, reliability, and security of HR...
- ...by Omega Academy for training delivery Develop Question Banks and use all technology-enabled training tools to enhance training quality and participant experience Take ownership of every training program handled to ensure all benchmarks are met or surpassed Act...
- ...Conduct quality audits of US medical billing processes to ensure compliance with healthcare regulations. Review and analyze coding practices including CPT, ICD-10, and HCPCS codes. Provide feedback and training to staff based on quality audit findings. Maintain...
- Give feedback and coach Process Coaches on their key job capabilities. Assign and monitor tasks that are aligned with the goals of training in supporting new hire and tenured agent performance as determined by TNIs and other support group analysis. Ensure that coaching...
- ...payers then perform necessary actions required for the task ~ Monitor activities of Nurses to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management. ~ Provide...
- ...Representative (CSR) with a healthcare background, particularly someone with a BS Nursing degree and an active Philippine Registered Nurse (PHRN) license, to provide exceptional support in a healthcare setting. As a CSR, you will serve as a bridge between patients, healthcare...
- ...Lead the setup and optimization of the call center operations for PHRN. Develop and implement standard operating procedures to... ...Train and mentor team members to ensure high performance and quality standards. Monitor call center metrics and generate reports for...
- ...Job Summary We are looking for a licensed Philippine Registered Nurse (PHRN) to join our team on a temporary work-from-home basis, supporting clinical appeals for inpatient denials and utilization review. The ideal candidate brings hands-on acute care experience alongside...
- ...VISION with OPERATIONAL EXCELLENCE At the heart of great partnerships we’ll always find EMPATHY WHAT IS YOUR ROLE As a Quality Assurance Specialist, you will be supporting various strategic business unit (SBU) teams and leadership to assess and ensure quality...
- ...Quality Assurance Manager – Content Moderation / AI Campaign Permanent / Full-Time Job Summary: We are seeking an experienced... ...efficiency Team Management & Coaching Lead a team of QA analysts and evaluators, providing training, coaching, and feedback to maintain...
- ...Work with the No. 1 Healthcare BPO An Accounts Receivable (AR) Executive with a PH Registered Nurse (PHRN) license and hospital experience typically works in healthcare-related financial operations, often within business process outsourcing (BPO) or medical billing...
- ...Enables full stack solutions through multi-disciplinary team planning and ecosystem integration to accelerate delivery and drive quality across the application lifecycle. Performs continuous testing for security, API, and regression suite. Creates automation strategy,...
- ...The Quality Management Representative (QMR) is responsible for overseeing, implementing, and maintaining the organization’s Quality Management System (QMS) in compliance with regulatory and industry standards for poultry processing. The QMR ensures that all processes—from...
- ...Quality Assistant Manager – Healthcare BPO Location: Ortigas, Pasig City (Onsite) Schedule: Night Shift Employment Type: Full-Time Job Summary We are seeking an experienced Quality Assistant Manager to join our Healthcare BPO operations team. The ideal...
- ...Manage a team of 5-10 SQ TLs spread across different LOBs. Coach, guide, and support Quality & Process Improvement teams to perform defined quality improvement tasks. Prioritize and allocate improvement projects based on internal and external quality data. Conduct...
- ...Quality Lead – Healthcare BPO Location: Ortigas, Pasig City (Onsite) Schedule: Night Shift Employment Type: Full-Time Job Summary We are looking for an experienced Quality Lead to join our Healthcare BPO team. The ideal candidate will have a strong...
- ...RBS Software Solutions is seeking a detail-oriented QA Engineer to oversee the quality assurance lifecycle of our enterprise-grade systems. This role is responsible for ensuring the reliability and functional integrity of mission-critical platforms through a strategic...
- ...Assist in maintaining quality standards and processes. Conduct regular inspections and audits of products and processes. Document and report quality issues to management. Support the development and implementation of quality improvement initiatives. Collaborate...
- ...of the collection team comply with industry regulatory requirements and internal compliance policies of the company. Record the quality inspection results, count the types and quantities of non-conforming items. University degree or above, preferably in finance, law...
- ...We Are Hiring: Quality Auditor At Cleanfuel, we’re looking for a detail-oriented Field Quality Control/Auditor to ensure the highest standards of performance and cleanliness across all our stations. If you are passionate about maintaining excellent service and operational...
- ...Spencer Foods Corporation (SFC) is a meat processing company focused on producing meat products in small batches to ensure optimum quality and taste. SFC caters to Institutional Accounts (B2B) and has a retail arm through Earle’s Delicatessen and distributors. Why Join...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to PHRN Quality Analyst. Be the first to apply!
