Quality Control Auditor (Remote)

North American Partners in Anesthesia•Saint Paul, MN

19h•Remote

About The Position

This role involves auditing the daily work of offshore Data Entry teams to ensure timely and accurate posting of charges within the billing system. The auditor will verify the accuracy and eligibility of insurance information for Anesthesia services and update the system accordingly. The position requires managing work queues, requesting new surgeon additions, recommending vendor education based on identified errors, and correcting insurance-related payor codes. A key part of the role is determining patient account eligibility, insurance product, and plan types using various tools like Availity, payer websites, direct contact with payers, and the hospital's EMR. The auditor will also ensure all insurance information is accurately entered, identify and correct discrepancies in patient insurance information, and make necessary changes to patient accounts based on reviews of medical records, demographic sheets, and EMR systems.

Requirements

High School Diploma or equivalent required.
Ability to prioritize and manage multiple requests and respond within designated timeframe.
Moderate computer skills.

Nice To Haves

1+ years of experience with insurance verification/Data Entry in the Medical field
Has a basic working knowledge of billing procedures, insurance reimbursement and guidelines preferably in a medical or anesthesia setting.
Has basic knowledge of insurance plans along with understanding guidelines for Medicare/Medicaid, government plans, HMOs, and PPOs.
One-year prior electronic medical records experience required (EMR/EHR)
Beginner Excel, Word, and Outlook skills
Team player that develops strong collaborative working relationships with internal team and can effectively engage and ability to build consensus among cross-functional teams.
Work requires focus, flexibility, and the ability to adapt to changing work situations.
Ability to maintain department benchmark for quality and productivity.

Responsibilities

Manage and process assigned work queues in a timely and productive manner with high quality.
Send requests for new surgeons to be added to the billing system.
Recommend vendor education based on errors found while resolving work queue tasks.
Review and correct insurance-related payor codes.
Determine eligibility, insurance product and plan types for patient accounts utilizing, Availity, payer websites, contact with payers, and hospital’s EMR.
Ensures all insurance information is obtained and entered in the system in an accurate manner.
Identify discrepancies in patient insurance information and corrects the insurance information within the billing system timely.
Reviews medical records, patient demographic sheets/face sheets and EMR systems. Make changes to the patient's account based on information reviewed.