Offer summary

Qualifications:

Minimum of 3-5 years of experience in revenue cycle management, billing, coding, or quality assurance in a healthcare environment., Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field is preferred., Experience with Medicare, Medicaid, and commercial payors is required., Certified Professional Coder (CPC) or similar certifications are preferred..

Key responsibilities:

Conduct audits across multiple projects to ensure compliance with company policies and regulatory standards.

Analyze patient accounts and documentation for accuracy and identify discrepancies and trends.

Provide clear audit findings and recommendations, focusing on error trends and training needs.

Identify opportunities for process improvements and maintain confidentiality of patient and company information.

Job description

Role Summary:
The Insurance Quality Assurance (QA) Specialist is responsible for auditing and reviewing the work of account representatives to ensure their activities align with company policies and regulatory standards. This role involves evaluating billing and coding practices, verifying claims, assessing documentation integrity, and ensuring adherence to procedural standards. The QA Specialist will also identify opportunities for improvement within the revenue cycle to enhance both financial performance and compliance. Regular feedback on error trends and areas of opportunity will be provided to operations.

Essential Duties and Accountabilities:

Conduct audits across multiple projects.
Analyze patient accounts and related documentation for accuracy and appropriate resolution.
Identify discrepancies, trends, and areas for improvement in assigned projects through data analysis.
Ensure the confidentiality and security of patient and company information at all times.
Provide clear, actionable audit findings and recommendations, identifying error trends and training needs.
Identify and propose opportunities for process improvements and share feedback with operations.
Consistently meet daily, weekly, and monthly targets for audit volume.
Maintain confidentiality with
Other duties as assigned.

Education/Experience/ Minimum Qualifications:

Minimum of 3-5 years of experience in revenue cycle management, billing, coding, or quality assurance in a healthcare environment.
Internal candidates: At least 1 year of experience with Meduit.
Bachelor’s degree in Health Information Management, Healthcare Administration, and/or a related field is preferred.
Experience with Medicare, Medicaid, and commercial payors is required.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar certifications are preferred.
Familiarity with Epic, Meditech, Cerner and ECW is preferred.
Ability to work weekends as needed.

Special Position Requirements:

Language Skills: Ability to read, analyze, and interpret information including training instructions and patient bills.

Mathematical Skills: Competence in basic arithmetic, including addition, subtraction, multiplication, and division of whole numbers, fractions, and decimals.

Reasoning Ability: Excellent attention to detail with strong analytical, problem-solving, and critical thinking skills.

Computer Skills: Proficiency in electronic health record (EHR) systems, billing software, auditing tools, and Microsoft Office Suite (especially Excel with formulas and pivot tables).

Work Requirements:

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to remain in a stationary position over 95% of the time. Constantly works in indoor weather conditions.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet.

Meduit is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, religion, sex, age, national origin, disability, military status, genetic information, sexual orientation, marital status, domestic violence victim status or status as a protected veteran or any other federal, state, or local protected class.

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