Patient Financial Services Quality Assurance Specialist

Signature Performance, Inc.

About The Position

Performs initial and regular audits on PATIENT FINANCIAL SERVICES team members for accuracy and compliance to department policies and procedures, and industry practices. Maintains proficiency in policy and procedures including updates and changes. Develops error tracking systems and data elements used to as QA criteria and scoring. Creates reports to track and monitor QA standards. Supports Creation of tip sheets for all staff members to help eliminate common errors or to address the work around processes for system limitations. Provides timely feedback on QA activities to associate's manager/supervisor. Responsible for providing industry metrics on productivity standards and establishes quality assurance protocols. Assists operations management with training needs, coordinating enhancements or needs assessments that are consistent with department policies and procedures. Works collaboratively with PATIENT FINANCIAL SERVICES leadership in the development of Performance Improvement coaching and education plans for those staff members that do not meet the minimum requirements on the individual QA scores. Participates in performance improvement through assisting with the implementation of policies and procedures, productivity standards, planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, tasks forces, cross-functional groups, projects and discussion with hospital and medical staff as observed by supervisor. Demonstrates thorough knowledge of hospital and clinic billing requirements, health insurance reimbursement principles, client-specific policy and procedures. Performs regular QA leveling exercises to assure all team members performing QA audits are consistently applying same scoring and methodologies. Remains updated on payer requirements, coding guidelines, and industry trends to inform training and QA efforts. Regular attendance at work is an essential function of the job.

Requirements

2-4 years of experience working with commercial, government billing or reimbursement processes may be substituted for education.
High School Diploma or GED equivalent
Associate's Degree in Billing, Coding, Business, or related field
Strong understanding of the end-to-end Patient Financial Services, including patient access, claims management, hospital and professional billing, and collections.
Knowledge of CPT, HCPCS and revenue codes and their effect on reimbursement.
2-4 years Experience in auditing, quality assurance, and training within a healthcare or insurance setting is often required.
Ability to communicate effectively both verbally and in writing.
Proficiency in relevant software systems and Microsoft Office Suite is typically expected.
Strong analytical, communication, and interpersonal skills are essential for effective training and collaboration.
Organized, self-motivated and able to work independently of direct supervision to carry out responsibilities.
U.S. Citizenship or naturalized citizenship is required for this position.
All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Nice To Haves

Familiarity with specific Electronic Health Record (EHR) systems like Epic, Oracle, and Meditech is preferred.

Responsibilities

Performs initial and regular audits on PATIENT FINANCIAL SERVICES team members for accuracy and compliance to department policies and procedures, and industry practices.
Maintains proficiency in policy and procedures including updates and changes.
Develops error tracking systems and data elements used to as QA criteria and scoring.
Creates reports to track and monitor QA standards.
Supports Creation of tip sheets for all staff members to help eliminate common errors or to address the work around processes for system limitations.
Provides timely feedback on QA activities to associate's manager/supervisor.
Responsible for providing industry metrics on productivity standards and establishes quality assurance protocols.
Assists operations management with training needs, coordinating enhancements or needs assessments that are consistent with department policies and procedures.
Works collaboratively with PATIENT FINANCIAL SERVICES leadership in the development of Performance Improvement coaching and education plans for those staff members that do not meet the minimum requirements on the individual QA scores.
Participates in performance improvement through assisting with the implementation of policies and procedures, productivity standards, planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, tasks forces, cross-functional groups, projects and discussion with hospital and medical staff as observed by supervisor.
Demonstrates thorough knowledge of hospital and clinic billing requirements, health insurance reimbursement principles, client-specific policy and procedures.
Performs regular QA leveling exercises to assure all team members performing QA audits are consistently applying same scoring and methodologies.
Remains updated on payer requirements, coding guidelines, and industry trends to inform training and QA efforts.
Regular attendance at work is an essential function of the job.