Revenue Cycle Quality Assurance Specialist

About the Role

Key Responsibilities

• Performs initial and regular audits on RCM team members for accuracy and compliance to department policies and procedures, and industry practices.
• Maintains proficiency in policy and procedures including updates and changes.
• Develops error tracking systems and data elements used as QA criteria and scoring.
• Creates reports to track and monitor QA standards.
• Supports creation of tip sheets for staff to eliminate common errors or address system limitations.
• Provides timely feedback on QA activities to associate's manager/supervisor.
• Responsible for providing industry metrics on productivity standards and establishing quality assurance protocols.
• Assists operations management with training needs, coordinating enhancements or needs assessments.
• Works collaboratively with RCM leadership in developing performance improvement coaching and education plans.
• Participates in performance improvement initiatives, policy implementation, and productivity planning.
• Demonstrates thorough knowledge of hospital and clinic billing requirements, health insurance reimbursement principles, and client-specific policies.
• Performs regular QA leveling exercises to ensure consistent scoring and methodology application.
• Remains updated on payer requirements, coding guidelines, and industry trends.
• Regular attendance at work is an essential function of the job.

Requirements

• High School Diploma or GED equivalent.
• Associate's Degree in Billing, Coding, Business, or related field.
• 2-4 years of experience working with commercial, government billing or reimbursement processes, which may substitute for education.
• Strong understanding of the end-to-end revenue cycle, including patient access, claims management, hospital and professional billing, and collections.
• Knowledge of CPT, HCPCS, and revenue codes and their effect on reimbursement.
• 2-4 years of experience in auditing, quality assurance, and training within a healthcare or insurance setting.
• Ability to communicate effectively both verbally and in writing.
• Proficiency in relevant software systems and Microsoft Office Suite.
• Strong analytical, communication, and interpersonal skills.
• Organized, self-motivated, and able to work independently.
• Familiarity with Electronic Health Record (EHR) systems like Epic, Oracle, and Meditech is preferred.

Nice to Have

• Familiarity with specific Electronic Health Record (EHR) systems like Epic, Oracle, and Meditech.

Benefits & Perks

• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match