Billing Quality Control Specialist
Summary of Major Responsibilities
The Revenue Cycle Quality Control Specialist supports the Revenue Cycle Department to ensure that the associates are providing the highest quality work. This position will review work performed by various functions of the revenue cycle department to make sure that quality standards are met. They will work with members of the Revenue Cycle Leadership Training teams as necessary to develop training and documentation materials based on key trends identified in the quality review process.
Essential Duties and Responsibilities
- Performs account reviews for each of the functions of the revenue cycle department which include but are not limited to the following: cash posting, eligibility, appeals, and statement processing.
- Provides coaching to revenue cycle team members based on audit outcomes.
- Uses Microsoft Excel to compile and track performance at an individual and department level.
- Creates weekly and monthly reports to show the number of accounts reviewed and outcomes of each review.
- Performs root cause analysis on missed quality goals. Develops and recommends action plans to reduce or eliminate root cause and improve operational performance.
- Stays current with relevant guidelines and policies for the Revenue Cycle department.
- Performs all job duties according to Revenue Cycle policies and procedures.
- Assists with special projects and other duties as assigned which could include facilitating ad hoc training sessions.
- Reports to work on time, and follows attendance guidelines.
- Conducts all assigned job duties in a timely and productive manner.
- Ensures compliance with all Company quality procedures and guidelines including but not limited to Quality Policy and Code of Business Conduct and Ethics.
- Stays current with relevant guidelines and policies for medical devices (e.g., HIPAA, Medical Device Reporting, etc.).
Necessary Education & Experience
- Must be 18 years of age or older and legally authorized to work in the United States.
- High School diploma or GED.
- Knowledge of International Classification of Diseases (ICD-coding).
- Knowledge of Insurance related information; i.e. Plan benefits, Explanation of Benefits (EOB), ANSI codes. Some college course work preferred but not required.
- Minimum of one year in a medical provider billing department within the health care industry.
- Demonstrated ability to create and maintain logs/charts in an accurate, organized and effective manner.
- Excellent verbal and written English communication skills.
- Excellent presentation and persuasive skills.
- Excellent quantitative and analytical skills.
- Ability to organize work, set priorities and work effectively in a diverse environment.
- Disciplined, self-motivated & reliable; able to stay focused on a task and work independently; motivated to perform quality work; diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
- Possesses a positive attitude with excellent interpersonal skills and the ability to interact and build strong working relationships with all levels of the organization.
- Ability to work in a team environment and adapt to changing workload and circumstances effectively; able to respond to new information quickly.
- Professionalism: conducts themselves in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients and associates.
- Minimum of three years of experience in billing systems functionality or billing auditing responsibilities.
- Associate Degree, Vocational/Technical degree or certification preferred.
Physical Requirements & Working Conditions:
- Subject to long or irregular hours.
- Subject to frequent interruptions.
- Position requires work in normal office environment.
- Work is generally sedentary in nature, but may require standing and walking for up to 10% of the time.
Exact Sciences is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, creed, disability, gender identity, national origin, protected veteran status, race, religion, sex, sexual orientation, and any other status protected by applicable local, state or federal law. Applicable portions of the Company’s affirmative action program is available to any applicant or employee for inspection upon request.
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