Revenue Cycle QA Auditor
About The Position
The Revenue Cycle QA Auditor reflects the mission, vision, and values of Resolution RCM and adheres to its Code of Ethics, Corporate Compliance Program, applicable policies and procedures, and regulatory and accreditation standards. The role provides quality audit services to evaluate and improve Revenue Cycle performance, ensures audits are accurate, objective, and timely, and produces documentation, performance reports, trend reports, and quality scorecards. The auditor identifies training and development needs, recommends action plans, processes audit disputes, manages internal customer relationships, and follows issues through to closure. The position reports to the Education and Quality Director.
Requirements
- At least five years of general hospital business office billing and collections experience.
- Understanding of accounts receivable management concepts for critical access hospitals (CAH) and general hospitals, and of business office operations.
- Expert-level billing and/or collections experience with Medicare, Medicaid, commercial insurance, and/or self-pay.
- Medical billing software expertise, including one or more systems such as Meditech (MAGIC, Client Server, or Expanse), CPSI, Medhost, EPIC, Rycan, Emdeon, Change, Relay Health, TruBridge, or Athena.
- Excellent written and verbal communication skills.
- Ability to manage workload, prioritize, and multitask in a fast-paced environment.
- Excellent people skills.
- Critical-thinking skills.
- Strong computer skills, including Word, Excel, and PowerPoint.
- Strong leadership, organization, planning, and time-management skills.
- Ability to grasp new concepts and apply them.
- Ability to understand complex workflows and follow procedures.
- High school diploma or GED.
Nice To Haves
- College degree or some college.
- Additional certification or training through CMS MedLearn, HFMA, AHAM, or AMA.
Responsibilities
- Provide quality audit services to evaluate and improve Revenue Cycle performance.
- Complete quality audits accurately, objectively, and in a timely manner.
- Complete documentation supporting audit work and individual and departmental reporting.
- Create performance reports for staff, departments, and leadership as required.
- Identify overall quality trends, produce reports, and provide input to the Education and Quality Director for training and development.
- Recommend action plans in collaboration with trainers, Managers, and/or Team Leads.
- Process audit disputes and provide thorough, timely feedback to management and the Education and Quality Director.
- Manage internal customer relationships and follow issues through to closure.
- Coordinate audit schedules to ensure compliance with quality audit procedures for staff and departments.
- Design and produce reports and individual quality scorecards as required.
- Provide input to the Education and Quality Director regarding department policies and procedures.
- Communicate quality audit results consistently to the appropriate Manager, Team Lead, and/or staff.
- Ensure compliance with quality sign-off and documentation procedures for Quality Auditors, the Department Manager, and Team Leads.
- Assess and communicate staff development needs to the Education and Quality Director and training team.
- Assist with developing training materials based on trends identified in monthly audits.
- Occasionally assist with staff training based on trends identified.
- Complete other duties assigned by the Education and Quality Director.
Benefits
- Medical, dental, vision, life, and short- and long-term disability coverage.
- HSA with employer contributions.
- Flexible spending accounts for health care and dependent care.
- Wellness platform with premium incentives.
- Employee assistance support.
- Voluntary supplemental plans, including accident, critical illness, hospital indemnity, and child disability insurance.
- Flexible paid time off offerings.
- Company-paid holidays.
- 401(k) plan with discretionary employer match opportunities.
- Professional development opportunities.
- Company-issued equipment.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
