Senior Medical Quality Assurance Analyst

Great vacations begin with great employees!

Combine your experience and sense of adventure by joining our exciting team of employees in Miami, FL.  Royal Caribbean Cruises Ltd. is pleased to offer a competitive compensation & benefits package, and excellent career development opportunities, each offering unique ways to explore the world. 

Position Summary:

The Risk Management Quality Assurance Lead is primarily responsible to ensure the quality of case management, medical records, pre-employment [PEME] and returning medical evaluation [REME] compliance and other departmental policies and procedures. The position will review medical billing procedures including examination of negotiated rates with health care providers, payment information and the turnaround time of claims. The position is responsible to identify trends in procedural errors and make recommendations to insure continuous improvement in processes and policy.

Career Snapshot:

• Oversees the quality of the claims management process to ensure compliance with policies and procedures and that Crew Medical delivers a consistent quality of care
• Evaluates Pre-Employment Medical Exams (PEMEs) and Returning Employment Medical Exams (REMEs) to ensure conformance to policy
• Investigates and reports allegations of fraud within the PEME/REME process
• Collaborates with the Medical Department to continually improve the selection and evaluation of approved medical providers
• Reviews the quality of injury reports, specific to occupational related illnesses and repetitive motion injuries, to ensure accurate classification and appropriate management of claim
• Audits the thoroughness of medical provider contracts and ensures contractual continuity of service. Reports and escalates anomalies
• Examines the crew claim management system reports to ensure crew, deemed "Fit For Duty", are effectively returned to work
• Monitors the effectiveness of the crew wellness program and makes recommendations for improvement
• Works with the medical billing company to identify and rectify inconsistencies in billing from providers. Identifies and reports on opportunities for savings
• Visits and audits approved medical providers to continually improve quality of service
• Analyzes data for errors, recommends improvements, develops best practices and documents findings in reports

Requirements:

• Bachelor's degree or directly related, equivalent experience in relevant areas of expertise
• A minimum of five years of relevant experience
• Experience with occupational medicine
• Experience in clinical documentation review/abstraction preferred.
• Knowledge of the physician billing process and medical record audit process.
• Knowledge of claims management processes
• Expertise to develop audit plans and tests to assure strong, efficient management controls
• Demonstrated analytical problem-solving skills as well as the ability to communicate effectively with all levels of management
• Ability to identify problems and bring them to amicable resolution
• Advanced electronic spreadsheet skills, i.e., Excel. Working knowledge of other Microsoft Office software

Preferences:

• Experience with claims management
• RN (Registered Nurse)
• One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CDIP (Certified Documentation Improvement Practitioner), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder)

Thank you for your interest in this role. Royal Caribbean Cruises Ltd. is the world's second largest cruise company, operating under Royal Caribbean International, Celebrity Cruises and Azamara Club Cruises brands. These brands offer an array of onboard activities, services and amenities, including simulated surfing, swimming pools, sun decks, beauty salons, exercise and spa facilities, ice skating rinks, in-line skating, basketball courts, rock climbing walls, miniature golf courses, gaming facilities, lounges, bars, Las Vegas-style entertainment, cinemas and Royal Promenades, which include interior shopping, dining and an entertainment boulevard.

Join our team as the Senior Medical Quality Assurance Analyst.  Once you click to apply below, it will take you 10-15 mins. to complete our application, which will help us better qualify your candidacy.   If you are being considered for this position you will hear back from us within the next < 30-60 > days.  During this time, you can view your application status on our career site. 

Join us at Royal Caribbean Cruises Ltd., where great vacations begin with great employees!

RCL is an Equal Employment Opportunity employer