Associate Analyst, ROC Quality Improvement

Now is the time to join Pacific Dental Services. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!

The Associate Analyst, ROC Quality Improvement will perform various functions in a production environment to ensure set expectations are maintained and controlled. This position has the sole responsibility of ensuring that user activities meet PDS standards of quality. The incumbent will perform audits aligned with department criteria, standards, and expectations and report findings to leadership. This role is key in delivering insights to the business leaders and ensures the final products are aligned with the overall performance benchmarks.

Responsibilities

• Daily account audits to determine alignment with standard operating procedures

• Summarizes analyses and reports findings to leadership for ongoing transparency and improvement.

• Assessing functionality and relevancy of quality improvement tools and processes

• Read and interpret quality data reporting for effective analysis.

• Perform database queries to validate test data.

• Continuously look at functions and process of ROC team and identify and resolve any noticeable patterns of errors by conferring with the management team.

• Investigate frequent errors occurred in processes.

• The candidate will be working in a fast-paced environment and will need to work well within our team, on multiple applications & applicable technologies.

• Research, document, and present trends in each department around quality and quantity.

• Draw up audit findings in a professional manner and prepare to discuss with management.

• Analyze claims, accounts, and patient information to ensure quality and quantity standard compliances.

• Oversee and interact with other PDS departments and team members regarding certain administrative operations within practices, including plan credentialing, eligibility, fees, pre-authorizations, billing, auditing, medical and claims follow-up.

• Other duties as assigned by management.

Qualifications

• 3+ years of experience working directly in claim billing lifecycle (centralized billing functions)

• Experience in dental industry, claims processing, and general knowledge of HMO/PPO insurances

• Ability to read and interpret EOBs (Explanation of Benefits).

• Epic software applications

• Microsoft Office Applications w/ intermediate knowledge of Excel

Preferred

• Bachelors Degree from accredited institution w/ focus on Healthcare, Business Administration or related field

• Prior quality assurance/account auditing experience

• Experience reporting analytics into summaries, charts, graphs, etc.

• Experience with change controls and tracking updates to shared documents

Knowledge/Skills/Abilities

• Requires knowledge of training practices, technology applications, and reporting systems; business correspondence and business reporting techniques; and business principles.

• Knowledge of dental office management and operations, as well as knowledge of best practices in dental for front office personnel.

• Ability to draw valid conclusions, apply sound judgement in making decisions, and to make decisions under pressure.

• Ability to interpret and apply policies and procedures.

• Display independent judgement by willingness to make timely and accurate decisions based on available information that is sometimes vague or limited in nature.

• Ability to prioritize tasks and projects with limited direction, while understanding and contributing to the success of the assigned regions.

• Ability to multi-task effectively without compromising the quality of the work.

• Excellent interpersonal, oral and written communication skills.

• Detail oriented, organized, process focused, problem solver, proactive, ambitious, customer service focused.

• Self-motivated, reliable individual capable of working independently as well as part of a team.

• Analytical skills to synthesize complex or diverse information. Ability to research information and analyze data to arrive at valid conclusions, recommendations, and plans of action.

Benefits

• Medical, dental, and vision insurance

• Paid time off

• Tuition Reimbursement

• 401K

• Paid time to volunteer in your local community

Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.