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Healthcare Billing Quality Specialist
2 months ago
The Healthcare Billing Quality Specialist plays a crucial role in delivering expert consulting services to healthcare professionals, including physicians, residents, and billing staff, ensuring adherence to patient care documentation, coding, and billing practices in line with regulatory compliance standards at federal, state, and local levels.
Key Responsibilities:
- Engages collaboratively across various levels to address and resolve billing and documentation challenges, utilizing external resources and professional expertise for ambiguous issues.
- Designs and implements educational programs, conducting training sessions for healthcare providers and billing personnel to ensure compliance with third-party documentation and billing regulations. This includes classroom instruction, online training, and personalized observation sessions.
- Serves as an active member of clinical department Billing Quality Councils, providing essential technical and regulatory guidance.
- Communicates findings and recommendations from audits to clinical departments, proposing actionable solutions for necessary improvements.
- Conducts internal assessments and oversees the quality review of external billing audits.
- Collaborates with healthcare providers and billing teams to identify and rectify documentation gaps.
- Develops and executes Clinical Documentation Improvement Programs in collaboration with clinical departments.
- Participates in various Health System committees and teams, representing the interests of the organization and its healthcare professionals.
- Creates and presents informative sessions to clinical faculty and billing staff.
- Undertakes special projects and additional responsibilities as assigned.
Minimum Qualifications:
- Education: Bachelor's degree preferred.
- Experience: Minimum of five years in a related field.
- Licensure: CCS-P or CPC certification required.
- Skills: Strong analytical and research capabilities, proficient in using personal computers, and intermediate skills in word processing, spreadsheets, presentations, and database software.
This position primarily involves sedentary work with extensive use of desktop computers. Occasional travel may be required for meetings and programs.
The Commonwealth of Virginia is committed to fostering a diverse workforce. We believe that diversity enhances excellence through the unique perspectives and experiences of each individual. We are an equal opportunity employer, ensuring that all qualified applicants receive consideration for employment without discrimination based on age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.
