Quality Assurance Vacancy At Allianz Egypt
The Quality Assurance Specialist – Review & Evaluation is responsible for activities concerned with review and inspection to apply quality standards for operational processes.
•Prepare concise documentation and audit reports, including recommendations to claims management for improvements with corrective action plans;
•Audit, assess, and monitor providers and payers, to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc. medical records, and independently codes, and abstracts.
•Analyze inpatient and outpatient medical records using most current International Classification of Diseases (ICD-9/ICD-10),Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes, regulatory and contractual requirements, and generally accepted coding practices.
•Verify and validate claims documents received through multiple channels to rule out possibility of documentation / coding errors or other inconsistencies that may occur in case of suspected fraud and abuse cases.
•Bachelors Degree (MBBS / Pharmacy)
•Minimum 3 years’ experience from Insurance / providers in processing/adjusting claims (e.g. ICD-9/10, CPT, HCPC)
•Demonstrated understanding of medical claims processes and procedures, and ability to recognize and interpret variances
•Legally permitted to work in the country of operations.
•Fluency in MS Office (Excel, Word, Outlook, PowerPoint) and general internet navigation and research skills