RCM Quality Assurance Specialist

Privia Health•Remote, USA

8h•$65,000 - $70,000•Remote

About The Position

The RCM Quality & Audit Specialist is responsible for ensuring the accuracy, efficiency, and compliance of the organization's revenue cycle processes. This role involves conducting audits, monitoring key performance indicators, identifying process improvements, and ensuring compliance with industry standards and regulations, including, but is not limited to claims, denial management, and functions for both onshore and offshore resources. The ideal candidate will have a strong background in medical billing, coding, and accounts receivable, with a focus on quality assurance and process auditing.

Requirements

3+ years recent, consecutive experience in an auditing/QA role or equivalent RCM job related experience
2+ years experience with athenaHeath and/or athenaOne preferred
Experience partnering with offshore RCM resources
Advanced working knowledge of Google Suite: Sheets (pivot tables, VLOOKUP), Slides and Forms
Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
Experience managing data located in multiple software systems
Experience documenting clearly defined processes, standard operating procedures and policies
Demonstrates effective written and verbal communication skills with the ability to self-edit
Must demonstrate strong interpersonal skills to interact positively and effectively
Ability to work in a very fast-paced and changing work environment
Must comply with HIPAA rules and regulations
Collaborative, customer-focused and able to create visible value
Ability to prioritize tasks, use sound judgment, and remain organized
Strong attention to detail and time management skills
Ability to accept constructive feedback and work towards self-improvement and professional growth

Nice To Haves

Associate’s or bachelor’s degree preferred
Experience with statistical analysis preferred

Responsibilities

Conduct quality reviews, audit revenue cycle claims and workflows against established standard operating procedures (SOPs)
Develop, collect, analyze, report and measure multiple quality improvement initiatives that supports RCM operational functions
Create and maintain quality measurements to track improvements in individual and team performance scores
Identify potential deficiencies in processes via analysis and trends
Create reports and deliver assessment/evaluation results to appropriate levels of leadership
Research and identify the “root cause analysis” in process improvement (e.g. Ability to identify when a function/action was performed that is not included in the SOP or documentation available) and utilize audit findings to report trends and recommended training
Assist with establishing, updating and communicating new and existing procedures
Analyze and measure results of implemented policies and changes
Collaborate with various RCM Leaders and internal partners to ensure goals are being met
Serve as a SME on all RCM workflows that are being audited
Participate in special projects, audits and process improvements in support of quality assurance initiatives
Other duties, as assigned i.e. coordinate and serve as supplemental support to the National Training Team