Hospital Billing and Follow-up Quality Assurance Specialist

The Hospital Billing and Follow-up Quality Assurance Specialist is responsible for the quality assurance of our medical billing department. In this role, you will be responsible for ensuring quality in areas including but not limited to AR, billing, collections, follow-up, analytics, and payer guidelines. This position holds additional duties with respect to research, and participation in root cause analysis and identifying process improvements and communicating results to provide performance feedback and continuous refinement.

Responsibilities

Conducts regularly scheduled reviews of accounts worked, and all related activities associated with resolution of claims.

Conducts analysis of issues holding up accounts and follows guidelines.

Ensures timely and accurate Revenue Cycle processes for areas of responsibility.

Identifies areas of utilization improvements and monitors expected outcomes.

Ensures the accuracy and completeness of billing processes, as well as monitors billing trends and provides recommendations for operational improvement.

Identifies recurring problems and procedural deficiencies and provides solutions to eliminate them.

Performs audits of A/R team, providing feedback and education based on results.

Develops overall educational materials based on common trends identified during the audit process.

Reviews, monitors, and tracks work queues in Epic and provides support as needed.

Performs other related duties as required or requested.

Qualifications

·       High school diploma or equivalency.

Relevant certification COC / Certified Outpatient Coder certification is a plus.

Maintain departmental productivity levels and compliance with quality standards.

A minimum of 5 years’ experience in hospital medical billing with a working knowledge of managed care, commercial insurance, and government payers.

A minimum of 3 year of prior experience translating billing error trending and quality assurance and translating these results into process improvements with minimum supervision required.

Proficiency in using medical billing software and EHR systems, (e.g., Epic, Unity, eCW, Meditech).

Attention to detail with the ability to identify/resolve problems and document the outcome.

Ability to collaborate effectively in a team setting to maximize quality and efficiency of operations.