Title: Quality Assurance Analyst
Job Purpose: The Revenue Cycle Quality Assurance Analyst is responsible for the quality assessment, audit, and analysis of RCM production staff in which the level of quality, as defined, is evaluated and scored.
This position is responsible for developing, recommending, and monitoring corrective and preventive actions within the Revenue Cycle department.
Essential Duties and Responsibilities
Compile data, perform audits, interpret and report back results to the management team defined by the company and/or departmental workflows.
Devise sampling procedures and directions for recording and reporting quality data.
Identify inefficiencies and process gaps that are contributing to decreases in performance and recommend best practices for ongoing process improvement.
Participate in documenting and prioritizing potential solutions to reduce errors.
Identify training needs and communicate opportunities to the leadership team.
Assist in drafting new and existing standard operating policies and procedures.
Ensure claims are adjudicated in compliance with provider contract parameters, member demographic information, and service level requirements through random and targeted claim reviews.
Ability to meet assigned deadlines and work under minimal supervision and with all levels of staff and management.
Achieve or exceed department goals as defined by the department management.
Other duties as assigned.
Minimum Qualifications, Education and Experience
Bachelor’s Degree Preferred (combination of education and industry experience may be considered in lieu of BS/BA)
Minimum of 5 years previous healthcare administration /revenue cycle, billing management with comprehensive knowledge of CPT, HCPC, and ICD-10 codes and medical terminology.
Working knowledge of full scope revenue cycle management process; patient registration, coding, billing, payment posting, revenue assurance, billing integrity, denial tracking/resolution, accounts receivable, medical terminology, payer contract familiarity with worker's compensation, and no-fault billing.
Extensive knowledge of and experience in large-scale receivables management.
Ability to perform strategic planning and prioritize goals.
Experience maintaining and integrating changes within the billing system.
Strong proficiency in Microsoft office with advanced Excel skills.
Strong analytical and problem-solving skills with the ability to identify trends, and opportunities for improvement and effectively communicate both orally and in writing and present information and respond to questions knowledgeably.
Ability to manage multiple projects.
Quality Standards
Team player who will lead by example and promote a positive work culture when partnering with internal/external business partners.
Demonstrates initiative, personal awareness, professionalism, and integrity, and exercises confidentiality in all areas of performance.
Follows all local, state, and federal laws concerning employment including but not limited to: I-9, Harassment, EEOC, Civil rights, and ADA.
Follows OSHA regulations and site protocols, policies, and procedures.
Follows HIPAA, compliance, privacy, safety, and confidentiality standards at all times.
Practices universal safety precautions.
Promotes good public relations on the phone and in person.
Adapts and is willing to learn new tasks, methods, and systems.
Reports to work regularly as scheduled; consistently punctual with respect to working hours, meal and rest breaks, and maintains satisfactory personal attendance in accordance with guidelines.
Consistently adheres to time management policies and procedures.
Completes job responsibilities in a quality and timely manner.
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