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PHRN Clinical Quality Evaluator (Medical Coding Certified)

Company

Carelon Global Solutions Philippines

Location

taguig, taguig

Type

Full-time

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise.

Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
  • Tracks and trends audit results, providing feedback to management.
  • Conduct calibration sessions to evaluate and ensure that all teams are aligned with the set QA guidelines.
  • Identifies and reports on systemic issues which create ongoing quality concerns.
  • Conducts root cause analysis to determine the underlying causes of noted quality opportunities using the RCA tools.
  • Recommend, implement, and monitor preventive and corrective actions to ensure that quality standards are achieved.
  • Generates ...

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