Overview
The Operational Quality Assurance Specialist III is responsible for auditing the work of RCM analysts to ensure the highest standards of services are delivered. The incumbent of this role plays a pivotal part in identifying process gaps and works closely with onshore and offshore teams to define SOPs and decision trees that will improve the processes.
At this time, US Anesthesia Partners does not hire candidates residing in New York, California, Hawaii, or Alaska.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES: (The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation)
- Applies quality assurance expertise by closely monitoring trends, identifying transactions and processes for audits, presenting audit outcomes and recommendations to mitigate gaps to the operations team for resolution.
- Utilizes tools and technologies available to ensure quality concerns are proactively identified and corrected.
- Works closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters.
- Ensures Standard Operating Procedures (SOPs) and client specific practice instructions are followed and reports any gaps identified with recommendations for improvement.
- Continuously improves the quality processes by suggesting innovative ways quality concerns can be quickly identified, fixed and monitored to avoid recurrence.
- Actively monitors for compliance as per HIPAA guidelines and reports any incidence of non-compliance.
- Actively participates in quality and training huddles, creates content, and delivers necessary training to resolve identified skill or knowledge gaps on the team.
- Audits for adherence to SOPs and other guidelines and provides references and feedback.
- Reviews customer feedback/concerns and ensures that corrective action is being taken, adhering to the plan of action.
- Provides feedback on SOPs so that the processes and procedures are created in such a way that these can be implemented most effectively.
- Proposes changes in decision trees through which inefficiencies and redundancies can be eliminated.
- Participates and contributes to the success of new clients by identifying any bottlenecks during implementations.
- Provides training and guidance to team members to improve their knowledge and skills so they are sufficiently equipped to deliver best in class services.
- Collaborates with the onshore quality team to ensure consistency on processes and procedures being followed across USAP locations.
- Performs additional projects and job duties as assigned.
Qualifications
KNOWLEDGE/SKILLS/ABILITIES (KSAs):
- Bachelor's Degree in related field preferred.
- Certification in Quality Improvement and Assurance preferred.
- 5+ years of relevant working experience in core Provider RCM out of which minimum 3 years as SME, QA, QA Lead, etc. within a professional setting.
- Hands-on knowledge of the key functions within RCM is a must.
- Prior experience working with healthcare systems is a plus.
- Experience working on process improvements/ six sigma quality projects preferred.
- Advanced excel skills such as the ability to use formulas to analyze data, create and format pivot tables and templates, use and conditional formatting and validation functions, able to create visualizations of data through charts, graphs and PowerPoint; able to manage information located in multiple software systems.
- Exceptional written, verbal, and interpersonal communication skills required.
*The physical demands described here are representative of those that may need to 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.
- Frequent hand, finger movement
- Use office equipment (in office or remote)
- Communicate verbally and in writing
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.
