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Revenue Cycle Quality Assurance Specialist buy in US, Free Classifieds Ads

Job Summary
The Revenue Cycle Operations Quality Assurance (QA) Specialist performs quality assurance reviews of insurance and denials management processes, claim and account detail, assuring quality, accuracy, timeliness and appropriateness standards are maintained and quality standards measured and achieved. Serves as subject matter expert with regard to revenue cycle systems used in the business unit needed to ensure appropriate use and maximum efficiency. In addition, performs process, operational and system workflow monitoring/reviews to ensure that efficient, cost effective work processes are being executed and/or creates tracking of areas that need to be addressed by management to optimize workflow, quality and performance. Maintains staff, unit and departmental report and scorecard creation and monitoring including benchmarks and time based tracking essential to monitor and take appropriate action regarding identified areas and or resources and e stablishes educational resource and reference materials as appropriate to support business unit as a direct outcome of quality assurance review findings.
Essential Duties:
Conducts daily, weekly and routine reviews of patient accounts worked by RCO employees in all related activities associated with resolution of claims.
Compiles productivity data for employees subject to QA review process, and prepares management reports on a weekly, monthly basis. Identifies opportunities for improvement, and establishes recommendations for the management team. Validates productivity measurements, and provides continuous monitoring of the efficacy of the production standards.
Performs daily, weekly and routine reviews of business unit processes to identify errors and areas where education/system enhancements are needed.
Responsible for auditing third party partners and vendors.
Prepares and maintains resource materials to support participate and lead training exercises and classes.
Completes QA analysis of all critical claims processing, follow up and denial elements using QA audit tools to correctly identify users. Review and respond to all quality audit inquiries which include disputed findings and implement quality assurance initiatives.
Performs routine system and process testing as requested by the RCO Systems or other operational areas.
Prepares monthly QA evaluation reports and submits detail and summary reporting to appropriate leadership
Identifies, recommends, documents and tracks resolution to process gaps and best practice to leadership for ongoing process improvements needed in the department.
Maintains QA electronic files, adding and deleting users, distribution lists and folders as needed.
Develops departmental SOP's as needed. Participates in local and enterprise-wide initiatives to promote data quality and quality improvement.
Computes and reports statistical QA data in a variety of formats, without computational errors, spotting trends and/or patterns.
Provides backend follow up support as needed.
Consults with manager on better operational procedures to improve overall efficiency and quality yields
Maintains in-depth knowledge of insurance follow up and denials systems, department policies, procedures and workflows.
PLEASE NOTE: This is not an exhaustive list of all duties, responsibilities and requirements of the position described above. Other functions may be assigned and management retains the right to add or change duties at any time.
RadNet is an equal employment opportunity employer and treats all applicants and employees in a fair and non-discriminatory manner without regard to race, color, religion, sex (including pregnancy), gender, gender-identity, national origin, ancestry, genetic information, citizenship, age, mental or physical disability, veteran/military status, qualified disabled veteran, marital/ domestic partnership status, religious creed, medical condition, sexual orientation, political activity, or any other characteristic protected by federal, state or local laws. RadNet does participate in E-I9 Verify.
Minimum Qualifications, Education and Experience
Minimum 3 years of billing or follow-up experience.
Knowledge of ICD Diagnosis, ICD Procedure codes, CPT codes and medical terminology.
Experience in monitoring quality with the ability to develop reporting systems required.
Revenue cycle system proficiency.
Must be detail-oriented and organized, with good analytical and problem solving ability.
Notable client service, communication, presentation and relationship building skills required.
Ability to function independently and as a team player in a fast-paced environment required.
Must have strong written and verbal communication skills.
Ability to excel with change and respond appropriately even in challenging situations.
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
High School diploma or GED required.
Associate's or Bachelor's degree preferred.

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