Operations Quality Analyst II

HMS is enterprising healthcare. We provide the broadest range of healthcare cost containment solutions in the industry – all to help payers like you improve performance.

The Operations Quality Analyst II is responsible for ensuring assigned deliverables meet HMS and client quality standards for accuracy, timeliness, and value.Responsible for performing quality assurance checks, working with stakeholders to articulate quality standards for deliverables, training and coaching stakeholders on meeting quality standards, and contributing to the on-going identification of improved methods and processes for achieving quality.

* Conducts and documents basic and moderately complex quality assurance checks of core product deliverables for clients prior to release, including: newly identified insurance policies, cycle claims selections for coordination of benefits billings, Provider Disallowance reports, and medical support enforcement files.Assists in identifying and correcting errors. * Communicates with Project Managers concerning scheduling of files for QA and errors identified as a result of QA review, working with Project Managers to solve problems. * Ensures deliverables meet client requirements through detailed review and analysis. * Works with client team to ensure Client Requirement documentation is current and thorough. * Maintains archive documentation of reviews performed in the QA database. * Uses Quality Review Tools to reviews processing benchmarks and counters, comparing results to prior experience, accounting for variations, cleans and specifies hold-backs. * Submits process improvement specifications for changes to processes to remediate historical problems or improve processes. * Recommends new processes and methods for streamlining/automating quality review processes or identifying errors in processing more efficiently. * Maintains quality reports, tools, electronic warehouses, and intranet portal. * Serves as liaison with other departments to ensure clear communication to the QA team of changing business requirements as reflected in the BeSure documentation. * Trains team members on performance of quality reviews.

**Required Skills:** * Ability to communicate both verbally and in writing, fluently in English. * Ability to be careful and thorough about detail. * Ability to analyze information and use logic/systematic thinking to address work-related issues and problems and to exercise independent judgment. * Ability to work proficiently with Microsoft Excel, Word, Access, and company databases to complete and document QA checks. * Average manual dexterity in use of a PC, phone, sorting, filing and other office machines. * Able to work effectively and efficiently in a team environment as well as to work independently. * Required periodic commitment to work additional hours in support of work volume fluctuations to meet revenue targets. * Limited to rare travel required, sometimes on short notice. **Required Education/Experience:** * Bachelors degree in business or related field, or equivalent work experience. * 2 years related work experience