Rev Cycle Quality Assurance Specialist

Performs Quality Assurance reviews and tracks productivity for staff within Revenue Cycle Management.  Staff roles include but not limited to: Hospital and Professional Billing, Collections, Denials, and Billing Edits, Cash posting, credit balances, and coding staff  to ensure billing, research and follow-up activities are performed to RCM standards.  
 

• Perform quality checks on a random sample of accounts for each staff member on a regular basis based on policy
• Prepare feedback on quality and quantity of output in the form of a written report and instructional information of audit results to manager.  
• Have knowledge of multiple computer systems in order to review accounts and perform staff audits with little to no interaction with others.
• Strong knowledge of billing office policies and procedures, third party payor rules, coding, and the systems used by staff in order to perform the role of Quality Assurance  and to report trends found during audits by payor group, work function, team, etc.
• Offers the department managers a best practice approach to get the accounts worked accurately and timely.
• Works directly with Directors, Managers and Team leads of each unit to insure quality outcomes.
• To communicate in a professional manner with directors, managers, team leads and staff to provide two-way communication about employee training and development needs. Feedback must be in a professional format as it may be used for development plans or disciplinary action
• Produce reports from the billing system(s) used for quality sample. Use a random approach to choose the sample for either monthly or quarterly reviews, depending on staff time in department and/or outcomes of prior reviews.
• By being subject matter experts,  offer assistance to other departments when available to help during peak workloads – maintain skills to provide work efforts to the normal work standard. The QAA is often needed to collaborate or complete projects for RCM. These projects will require analysis of the expected outcomes, and how to complete them with a focus on quality and deadlines.
• Collaborate on training materials and works with Education Analysts, Team Leads, Managers, and Director to provide feedback to improve staff productivity
• Provide one-on-one training with staff as needed to clarify errors on reviews.  

Education: High School diploma required.  Associate Degree in Business or related field preferred, or equivalent work experience as defied below is required.
Experience: Five years of experience in physician or hospital based insurance billing, knowledge of ICD/CPT/HCPCS coding, and medical terminology helpful. Computer experience in EPIC and Microsoft required.  
Licensure, certification, and/or registration: Epic certification/proficiency required upon accepting position or to be completed in first 6 months in position. CPC desired.
Other Minimum Qualifications: Effective oral and written communication skills. Must be a team player with initiative, organization skills, analytical abilities, detail orientated, and the ability to work independently as well as within a group. Must be able to work flexible hours including overtime when needed.

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