Overview
The purpose of the QA Specialist TL position is to provide key data needed to drive continuous improvements within the RCM teams. The QA Specialist TL will specifically focus on adherence to all USAP compliance policies and operational workflows. This will be done through process audits, written reports, and analysis of the reports as needed. Work products and outputs will include detailed audits and reports to identify process and quality deficiencies, analysis, and recommended plans of actions to improve audited processes, as well as to recommend training needs. The QA Specialist TL will assist Management in routine reviews of policies and procedures and the implementation of improvement plans as needed. This person has increased knowledge of role and a complete understanding of their work as it relates to the business and consistently meets productivity and quality measures; requires little to no oversight or supervision. This person is expected to set the tone of collaboration, excellence, and positivity within the team. This role is expected to maintain the highest level of confidentiality regarding auditing results.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):
- Audit work in the RCM departments, including but not limited to, Billing, Cash Management, Accounts Receivable, Customer Service, Payor Contract Management, to ensure compliance with policies and procedures, expected system functionality usage, and departmental workflows
- Partner with colleagues to ensure all auditing needs are met
- Act as a Subject Matter Expert (SME) within the auditing team and both a national and regional level
- Complete user and workflow audits in a timely manner, enabling department leadership to use audit data to improve and drive positive changes
- Participate in rebuttal process with QA leadership direction.
- Identify specific individual and department training needs, and assist in ongoing process improvement opportunities through audit analysis
- Partner with the Education & Development department to assist in development and implementation of education programs based on identified quality issues
- Review of policy changes, and implementation of those changes, into audit process and reporting
- Maintain up-to-date knowledge of department specific workflows, processes and system configuration updates, by actively partnering with RCM leaders
- Provide feedback to the Education and Development team regarding training materials to ensure they are updated as needed
- Perform ad-hoc audits as needed
- Work with the Process Improvement departments to improve quality and performance through process improvement initiatives
- Maintain strictest confidentiality
- Coordinate and facilitate local and national QA meetings, and be an active player in achieving annual departmental goals
- Responsible for drafting Monthly Audit Review Summaries for departmental leadership
- Responsible for developing and facilitating monthly reports, including content used for executive summaries
- Perform & coordinate audits on peers, locally and nationally, to drive continuous improvements within the QA teams
- Successfully mentor and train auditors with a focus on each team member’s professionalgrowth
- Proactively outline work assignments needed and guide team as necessary
- Consistently demonstrate a Servant Leadership style when working with their team or cross functional teams
- Performs other duties, as assigned
Qualifications
JOB REQUIREMENTS (Knowledge, Skills and Abilities):
- Excellent verbal and written communication skills
- Ability to prioritize work
- Strong background in lifecycle of a claim, collection and billing knowledge is essential
- Experienced with AthenaIDX requiredKnowledge of anesthesia billing required
- Analytical skills to summarize audit findings into statistically meaningful reports
- Strong presentation and written skills
- Ability to work effectively and independently with RCM staff
- Must have keyboard skills with knowledge of Microsoft Word, PowerPoint
- Intermediate Excel skills
- Must have a pleasant disposition and high tolerance level for diverse views, varied skill levels, and positions
- Ability to work independently with little to no supervision
- Ability to adapt to a quick paced environment that may include changing priorities
- Willing and eager to assist team members in achieving overall department productivity requirements
- Strong time management skills
- Ability to read, write, and speak English
EDUCATION/TRAINING/EXPERIENCE:
- High School diploma or equivalent
- Minimum 5 years working directly within RCM for a healthcare provider
- Minimum 3 year working in an RCM role where auditing is a primary responsibility
PHYSICAL REQUIREMENTS:
- Requires prolonged sitting, some bending, stooping, and stretching
- Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator, and other office equipment
- Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations
- Requires lifting papers and boxes weighing up to 35 pounds occasionally
- Requires dexterity to type at least 35 wpm
WORKING CONDITIONS (environment and safety):
- Work performed remotely
- Involves frequent contact with professional staff
- Work may be stressful at times
- Interaction with others is frequent and often disruptive
DISCLAIMER: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.
US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.
