Revenue Cycle Multi-Specialty Quality Assurance Specialist

Jorie AI•Oak Brook, IL

39d•Remote

About The Position

The Revenue Cycle Multi-Specialty Quality Assurance Specialist is responsible for evaluation and ensuring accuracy, and efficiency of end-to-end revenue cycle processes, various medical specialists. This role plays a pivotal role in maintaining quality standards related to eligibility verification/ authorizations, charges, basic/minimal coding, billing, collections/reimbursement, payment posting, and patient billing. The QA Specialist works closely with the QA manager to identify areas of improvement, root cause analysis, provide recommendations and assist with streamlining of processes.

Requirements

High school diploma or equivalent
3 or more years of end-to-end revenue cycle operations experience
Adequate knowledge of all functions in the revenue cycle
Experience with payer rules, Medicare, Medicaid, commercial and managed care
Experience with EMR systems

Nice To Haves

Previous QA experience in a revenue cycle setting
Excellent written and verbal communication skills
Ability to manage tasks in an ever-changing environment.
Strong analytical and critical thinking skills
Attention to detail with the ability to identify and resolve problems and document practical solutions.

Responsibilities

Conducts routine audits of end-to-end process assignments to ensure proper SOP/guidelines are met.
Evaluates eligibility verification and pre – authorization processes.
Evaluates basic coding, charge entry, billing, and claims process, in addition to denied claims to ensure accuracy.
Identify trends, root causes and system issues related to denials, no response, or underpayments.
Collaborate with management to develop and implement process improvement plans.
Maintain QA reports and complete timely weekly/monthly submissions.