IT-BPM - Associate III - BPM
Company: NR Consulting LLC
Location: Aliso Viejo
Posted on: June 22, 2022
Job Description: Proficiency: A Voice Associate: Able to
independently take customer support calls effectively and
efficiently ;follow the SOPs to complete the process and endeavour
to resolve the issue, handle some escalated issues or escalate to a
more knowledgeable person to resolve, in alignment with SLAs and
assists Lead I BPM.
A Data Associate should independently be able to effectively and
efficiently process the transactions assigned in timely manner,
clarify complex transactions to others and ensure that quality of
output and accuracy of information is maintained, in alignment with
SLAs and assists Lead I BPM.
Expectations from this role:
Independently achieves the following; guiding other process
associates and assists Lead 1 - BPM
1. Service Level Agreement (SLAs) specified by the client in terms
of quality, productivity and schedule should be managed to ensure
2. [Data]: Analyze information, enter and verify data, follow the
SOP to ensure completion of the task. [Voice]: Customer calls,
responses and any updates or edits to workflow based on after call
work should be performed as per directions.
3. Address performance issues and improvement plans of team and
self with supervisor.
4. Expected to be proficient in the process and domain to ensure
quality of transactions and guide the same to the process
5. Perform QA for production associates as an expert in the
function and ensure completion within SLAs.
6. Create reports on performance metrics for team to manage
7. Understand the process and bring forward ideas and solutions to
simplify and automate them to increase operational efficiency.
Create automation solution and submit the same to Lead I for
Typical performance measures:
1. 100% Adherence to quality standards
2. Adherence to turnaround time for response and resolution
3. Completion of all mandatory training requirements
4. 100% adherence to process and standards
5. 100% adherence to SLAs where applicable
6. Number of issues fixed/tasks completed
7. Number of non-compliance issues with respect to SOP
8. Zero/No Client Escalations
9. Number of high-quality RCA and QA output
10. Daily/weekly performance reporting
11. Mentors A1 and A2 resources on the processes
Processing [Data]: Processing transactions assigned as per SOPs
Handling calls [Voice]: Handle customer support calls, resolve
issues and complete after-call work
1. Production: Take calls (voice) or process complex transactions
2. Issue Resolution:
" Address any problems with the supervisor/QA to ensure maximum
productivity and efficiency.
" Identifies, analyses and solves the incidents/transactions.
" Proficient in the process, assisting other team members who are
new to the process as well to ensure quick readiness of the
" Take steps to improve performance based on coaching.
" Production readiness of new joiners within agreed timeline by
providing guidance Actively participate in the team's or
organization wide initiatives
" Able to handle and manage higher complexity tasks.
" Be aware of any client s process or product updates and ensure
100% compliance towards the same.
" Adhere to release management process.
" Thorough understanding of organization and customer defined
process. Consult with mentor when in doubt.
" Adherence to defined processes.
" Adhere to organization s policies and business conduct.
5. Reporting: Create reports on specific SLAs/performance
6. Stakeholder Management: Guide the team in preparing status
updates and keep management updated about the status.
" Attends one on one need-based domain/project/technical trainings
" On time completion of all mandatory training requirements of
organization and customer.
" Provide on floor training and one to one mentorship for new
8. Escalation: Escalate problems to appropriate individuals/support
team based on established guidelines and procedures.
9. Monitoring: Monitor progress of requests for support and ensures
users and other interested parties are kept informed.
10. Manage knowledge: Consume project related documents, share
point, libraries and client universities
" Mentor and provide guidance to peers and junior associates.
" Assist new team members in understanding the customer
12. Communication: Status update to the respective stakeholders and
within the team
" Collaborate with different towers of delivery for quick
resolution (within SLA); document learning's for
" Collaborate with other team members for timely resolution of
1. Customer Focus: Focus on providing a prompt and efficient
service to customers, goes out of the way to ensure that individual
customer needs are met.
2. Attention to detail to ensure SOPs are followed and mistakes are
not knowingly made
3. Team Work: Respect others and work well within the team.
4. Communication: Speak clearly and write in a clear and concise
manner. Uses appropriate style and language for communication
5. Communication: Speaks in an accent neutral manner or with the
accent required for the process, with good vocabulary and grammar
skills. Writes clearly (Voice)
6. Typing Speed with 15WPM and 80% accuracy
7. Analytical approach: Makes systematic judgments based on
information and relevant assumptions.
8. Ability to follow SOP documents and escalate the alerts within
the defined SLA Willingness and ability to learn new skills, domain
9. Make rule based and discretionary decisions.
10. Process Trainer/Sr. QA/Domain Expert/MIS Analyst
11. Frontline resource - Voice/Backoffice, Quality Auditors, SME,
1. Expertise with Windows Operating Systems, MS Office tools
2. English comprehension Reading, writing and speaking
3. Domain knowledge based on process (healthcare, banking,
investment, F&A, retail, customer support, etc)
4. Familiarity with work allocation and intake functions
5. Familiarity with quality control processes including pare to
analysis and root cause analysis
6. Knowledge on security policies and tools
7. Good understanding of customer infrastructure, ability to
8. Experience level 3 to 7 years
Comments for Suppliers:
The Auditor, DRG Coding & Clinical Validation position has an
extensive background in nursing, inpatient coding and reimbursement
guidelines and specifically has a solid understanding of the
MS-DRG, AP-DRG and APR-DRG payment systems. This position is
responsible for auditing client data and generating high quality
recoverable claims for the benefit of Cotiviti and our clients.
Responsible for performing clinical reviews of medical records and
other documentation to evaluate issues of coding accuracy, medical
necessity, and the appropriateness of treatment setting, and
services delivered. Primarily responsible for auditing efforts by
executing projects assigned by the Director, Audit Operations or
Manager, Audit Operations. Displays professional skepticism that
enhances the work performed to achieve success in position. Key
Responsibilities:- " Identifies and Enters Claims. Integrates
medical chart coding principles and objectivity in performance of
medical audit activities. Draws on advanced ICD-9 and ICD-10 coding
expertise and industry knowledge to substantiate conclusions.
Performs work independently, reviews and interprets medical records
and applies in-depth knowledge of coding principles to determine
potential billing/coding issues, and quality concerns. "
Effectively Utilizes Audit Tools. Utilizes with advanced
proficiency, Cotiviti and client tools required to perform duties.
Enters the claim into Cotiviti system accurately and in accordance
with standard procedures. Updates current reports, develops and
runs custom queries and validates accuracy of current reports used.
Makes determinations based on prior knowledge, experience of client
contract terms with the likelihood of recovery acceptance. " Meets
or Exceeds Standards/Guidelines for Productivity. Maintains
production goals and quality standards set by the audit for the
auditing concept. Audits against the expected level of quality and
quantity (i.e., hit rate # claims written, ID per hour). " Meets or
Exceed Standards/Guidelines for Quality. Achieves the expected
level of quality set by the audit for the auditing concept, for
valid claim identification and documentation. " Prepares Responses
to Client Disputes. Provides independent verification of claims
validation, insurance, or employer validation in a concise written
manner. " Reviews Provider Contracts. Demonstrates high level of
expertise in researching requirements necessary to make
recommendations on client contracts to fit projects within standard
reports such as medical policies and state and federal statutes. "
Identifies New Claim Types. Identifies potential claims outside of
the concept where additional recoveries may be available. Suggests
and develops high quality, high value concept and or process
improvement, tools, etc. " Recommends New Concepts and Processes.
Has broad in-depth knowledge of client, contract terms and complex
claim types gained from extensive healthcare auditing experience.
Suggests, develops, and implements new ideas, approaches and or
technological improvements that will support and enhance audit
production, communication and client satisfaction. Evaluate
information and draw logical conclusions. Collaborates with Data
Services in developing new reports. Education & Work Experience "
Associates Degree or equivalent relevant experience required.
Bachelor s degree in Nursing, Healthcare Economics, Health
Information Management, and/or Business, preferred, or 5 - 7 years
experience (experience in any of the following: claims
auditing/quality assurance/recovery auditing - ideally in a DRG /
Clinical Validation Audit setting or hospital environment) strongly
preferred. " Strongly required Nursing education (ASN, BSN, or
MSN); active, unrestricted license. " Three (3) years practical
Clinical /Nursing experience in an inpatient setting is preferred.
" Coding certification required and maintained as a condition of
employment. (CCS, CIC, CPC, RHIA, RHIT, CCDS or CDIP
Keywords: NR Consulting LLC, Aliso Viejo , IT-BPM - Associate III - BPM, Accounting, Auditing , Aliso Viejo, California
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