Priority Claims Specialist III
Hanger, Inc.
Quality Assurance Specialist, Revenue Cycle – Multi-Specialty
Jorie AI
full-time
Posted on:
Origin: • 🇺🇸 United States • Illinois
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
RPA
About the role
- The Revenue Cycle Multi-Specialty Quality Assurance Specialist is responsible for evaluation and ensuring accuracy, and efficiency of end-to-end revenue cycle processes across various medical specialties
- Maintains quality standards related to eligibility verification/authorizations, charges, basic/minimal coding, billing, collections/reimbursement, payment posting, and patient billing
- Works with QA manager to identify improvement areas, perform root cause analysis, provide recommendations and assist with streamlining processes
- Conducts routine audits of end-to-end process assignments to ensure proper SOP/guidelines are met
- Evaluates eligibility verification and pre-authorization processes
- Evaluates basic coding, charge entry, billing, and claims processes, in addition to denied claims to ensure accuracy
- Identifies trends, root causes and system issues related to denials, no response, or underpayments
- Collaborates with management to develop and implement process improvement plans
- Maintains QA reports and completes timely weekly/monthly submissions
Requirements
- High school diploma or equivalent
- 3 or more years of end-to-end revenue cycle operations experience
- Adequate knowledge of all functions in the revenue cycle
- Experience with payer rules, Medicare, Medicaid, commercial and managed care
- Experience with EMR systems
