Quality Auditor Specialist

1 week ago

Chapel Hill, United States UNC Health Full time

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

This Quality Auditor Specialist position primarily works to identify issues associated with Hospital and Professional Authorization denials, Registration Eligibility denials, and pre/post edits related to registration and insurance verification. They also work other data-driven quality audits and help expand our department's growing repository of process documents.

This position reports directly to the Manager of the Project, Quality, Systems, and Training ("PQST") team in the Physician Insurance Billing and Follow Up department. It supports both the Pre-Services and PB Claims groups within the department.

Responsibilities:

Conduct monthly quality audits on work done by team members in the Pre-Services group of our department. The main focus for this set of audits is reviewing follow up work for eligibility, registration, and authorization denials.

Conduct other monthly audits for work done team members in the PB Claims group of our department. These include reviewing adjustments made by team members and the quality of requests for action submitted within and between teams.

Conduct ad hoc or limited scope audits as needed.

Record findings and communicate them to leadership (supervisors, managers, directors) using established documentation processes. Provide recommendations as appropriate.

Create new process documents in accordance with established documenting conventions.

Provide direct assistance to teams to reduce accounts receivable by performing work in WQs as assigned.

Carry out special projects as assigned.

Analyze denials, user workflows, and system automation to identify unwanted outcomes and root causes. Communicate information to leadership regarding any patterns or trends found.

Provide training on workflows as needed.

Other details:

The ideal candidate will...

...have experience with registration/eligibility/authorization denials and working them in various contexts in EPIC (charge review, claim edits, follow up) and be knowledgeable in RTE functions.

...have a strong ability to organize and communicate complex information.

...demonstrate a strong commitment to process improvement.

...have an interest in understanding how EPIC works.

...identify potential areas for improvement that could become special projects based on observations they have made while completing other work processes.

Other Information

Other information:
Education Requirements:
• High School or GED
Licensure/Certification Requirements:
• No licensure or certification required.
Professional Experience Requirements:
• Requires three (3) years of experience in a clerical, accounting or customer service setting.
Knowledge/Skills/and Abilities Requirements:
• #NAME?

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Physician Ins Billing and Foll

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $20.88 - $30.02 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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