RCO Quality Assurance Specialist

1 month ago

Fairport, United States RadNet Full time
Job DescriptionJob Description

Responsibilities

Artificial Intelligence; Advanced Technology; The very best in patient care. With decades of expertise, RadNet is Leading Radiology Forward. With dynamic cross-training and advancement opportunities in a team-focused environment, the core of RadNet’s success is its people with the commitment to a better healthcare experience. When you join RadNet as a Revenue Cycle Operations, Quality Assurance Specialist, you will be joining a dedicated team of professionals who deliver quality, value, and access in the 21st century and align all stakeholders- patients, providers, payors, and regulators achieve the best clinical outcomes.

JOB SUMMARY

The Revenue Cycle Operations (RCO) Quality Assurance (QA) Specialist performs quality assurance reviews of RCO workflows, assuring quality, accuracy, timeliness and appropriateness standards are maintained and quality standards measured and achieved. Processes incoming compliance and regulatory audits/reviews/inquiries/complaints; to determine the next course of action based on the workflows for each; gathers and prepares all documentation for review by the QA Analyst. Collaborates with other areas of RCO, as well as, Clinical Operations and Credentialing to gather all information pertinent to the compliance and regulatory correspondence received. Performs process, operational and system workflow monitoring/reviews to ensure that efficient, cost-effective work processes are being executed. Assists QA Analyst and Documentation Analyst in creating educational resource and reference materials as appropriate to support business unit as a direct outcome of quality assurance review findings.

You will:

  • Completes QA reviews of all critical claims processing, follow up and denial elements using QA audit tools to correctly identify opportunities. Review and respond to all quality audit inquiries which include disputed findings, and implement quality assurance initiatives as appropriate.
  • Classifies and assesses all Compliance and Regulatory audits/reviews/inquiries/complaints received and determines key and critical responsible area(s).
  • Works with RCO, and other RadNet areas to obtain all required documents.
  • Compiles data required and ensures it is complete and accurate, submits approved data to requestor via correspondence workflow and documents patient account as needed.
  • Performs regularly scheduled reviews of business unit processes to identify errors and areas where education/system enhancements are needed.

If You Are:

  • Minimum of 3 years of previous healthcare administration/revenue cycle, billing management with knowledge and understanding of CPT, HCPC, and ICD-10 codes and medical terminology.
  • Experience in monitoring quality with the ability to develop reporting as required.
  • Revenue cycle system proficiency.
  • Must be detail-oriented and organized, with good analytical and problem-solving ability.
  • Notable client service, communication, presentation and relationship building skills required.
  • Ability to function independently and as a team player in a fast-paced environment required.

Ideal Candidate will possess:

  • Communicates, cooperates, and consistently functions professionally and harmoniously with all levels of supervision, co-workers, patients, visitors, and vendors.
  • Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
  • Follows all local, state and federal laws concerning employment to include but not limited to: I-9, Harassment, EEOC, Civil rights and ADA.
  • Follows OSHA regulations, RadNet and site protocols, policies and procedures.
  • Follows HIPAA, compliance, privacy, safety and confidentiality standards at all times.

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