Quality Assurance Analyst (Revenue Cycle Management)

Overview

As a Quality Assurance Analyst, you will be responsible for all the system audits within the Revenue Cycle Management department.

Quality improvement is a continuous process conducted within the RCM department which assesses the quality of the work performed by the internal RCM teams by measuring the accuracy of key departmental processes and team performance.

The goal of quality improvement is to continuously identify opportunities for improvement that will impact revenue.

Responsibilities

• Perform quality audits on a daily basis by reviewing all actions taken by any revenue cycle management team member.
• Create & utilize spreadsheets, quality management tools and reports, and graphs to communicate data
• Provide formal report(s) on audit while communicating and collaborating with supervisors and management team to consistently inform them of key findings and trends.
• Explore areas for improvement based on collected data and work with the management team to identify and implement potential solutions
• Design, implement, and manage quality improvement projects with the support of the RCM management team.
• Keeps up-to-date on the following knowledge areas :
• Revenue Cycle workflows
• Revenue cycle software system upgrades and enhancements
• Clinic department operations
• Medicare regulations and commercial billing guidelines
• Adult education theory and technologies
• NextGen systems patient access and revenue cycle systems
• Keeps abreast of trends as they relate to revenue cycle best practices by self-study, attending job related conferences and courses which enhance personal development and strengthen the services provided.

Keep apprised of new technologies offered in the related field.

• Maintains comprehensive knowledge of 3rd party billing requirements and reimbursement principles.
• Acts as a designated super user for patient accounting system.
• Assists in creating and maintaining master patient build in the training environment to support training and testing initiatives.
• Be flexible with own work schedule to accommodate the needs of customer departments.
• High level of organization, time management and delegation skills necessary to prioritize and adjust work flow as volume and deadlines mandate.
• Assist in diagnosing problems with files that fail compliance or do not process correctly.
• Research and resolve discrepancies in a timely manner.
• Perform other duties as assigned.
• Perform other duties and participates in special projects as directed

Qualifications

• High School Diploma or GED required; BA / BS in Business Administration, Healthcare Education, Finance or equivalent is preferred
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• 5+ years in a revenue cycle management (patient financial services / patient access) or compliance-related role
• 5+ years of experience preferred as a trainer / educator in a healthcare environment, to include both classroom delivery and instructional design
• Demonstrated experience working in Microsoft Office - Excel (advanced formulas, pivot tables), PowerPoint, Word and Outlook
• Recent experience delivering training or quality feedback in a healthcare environment
• Experience working with NextGen Practice Management preferred
• Self-motivated and detail-oriented
• Excellent interpersonal skills including conflict management.
• Well organized and demonstrated ability to meet deadlines.
• Strong Knowledge of Medicare, Medicaid and Commercial payer guidelines.
• Working knowledge of cpt, hcpcs and diagnosis coding.
• Demonstrated ability to multi task and work well under pressure.
• Ability to analyze and interpret information and to prioritize and re-prioritize as necessary.
• Comprehensive knowledge of HIPAA Rules & Regulations
• Demonstrated knowledge of revenue cycle applications is required.
• Experience with Electronic Health Record systems or other software implementation training programs.
• Expert conceptual, analytical, and problem-solving skills.
• Exceptional communication skills, both oral and written.
• Cooperate interdepartmentally, articulate ideas, and negotiate resolution of issues to achieve objectives.
• Strong customer service-oriented focus in all decisions and actions; professional aspect and attitude at all times.

Benefits & Perks

Your health, happiness and your future matters! At AVP, we offer everything medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays plus PTO, Sick Time, opportunity for growth, and much more!