Senior Quality Assurance Specialist
2 weeks ago
- Sure that project-related quality processes are followed by denials analysts and client-specific metrics are achieved.
- Prepare detailed reports on audit findings and understand quality requirements from process and target perspectives. Deliver reports in a timely manner.
- Identify methods to achieve quality targets and implement them in consultation with QCA leads and/or managers. Assist with the Quality Assessment process to ensure all quality standards can be met.
- Participate in performance improvement activities and continuing education to maintain current credentials and enhance knowledge and skills.
- Share relevant information with the team and take initiative to ensure team members complete projects.
- Participate in client presentations of findings when requested.
- Adjust workloads as necessary to achieve successful project completion.
- Handle complaints, questions, and queries as necessary.
- Disseminate changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance.
- Foster an environment of teamwork and service excellence within the department.
- Participate in conference calls/meetings with management and staff to ensure performance and training recommendations are addressed and improvement suggestions are implemented.
- Assist in new hire training classes, transition periods, and refresher trainings as needed.
- Maintain knowledge, understanding of, and compliance with all policies and procedures.
- Participate in presentations to educate staff on outcomes and plans of correction.
- At least 2 years previous work experience as a Quality Analyst in healthcare insurance collections, self-pay collections, and customer service in a call center setting or compliance and/or training.
- Experience with training new users.
- Knowledge of EOBs, CPT, ICD-9, and 10 codes, HCFAs, UB92s, HCPCS, DRGs, and authorizations/referrals.
- Strong understanding of basic healthcare revenue cycle operational processes such as functions of insurance, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial Practices.
- Experience with practice management systems (EPIC PB, Allscripts, and/or Cerner preferred).
- Knowledge of the denied claims and appeals process.
- Must have experience in outbound transaction AR process (Payers).
- Ability to navigate through multiple software and computer applications.
- Detail-oriented and well-organized.
- Capacity to maintain a high level of objectivity when completing staff reviews.
- Self-motivated and resourceful with the ability to multitask and successfully operate in a fast-paced, team environment.
- Ability to work well individually and in a team environment.
- Strong analytical and organizational skills.
- Strong interpersonal skills with the ability to communicate well at all levels of the organization.
- Strong problem-solving and creative skills with the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
- High level of integrity and dependability with a strong sense of urgency and results-oriented.
- Ability to meet assigned deadlines and work under minimal supervision and with all levels of staff and management.
- Excellent written and verbal communication skills required.
- Gracious and welcoming personality for customer service interaction.
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