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Revenue Quality Assurance Specialist

2 months ago

Phoenix, Arizona, United States Sonora Quest Full time
Job Summary

Job Title: Revenue Quality Assurance Specialist

Job Summary: We are seeking a highly skilled Revenue Quality Assurance Specialist to join our team at Sonora Quest. As a key member of our Revenue Department, you will be responsible for identifying and evaluating quality and productivity, training new employees, and ensuring compliance with all policies and standard operating procedures.

Key Responsibilities
  1. Quality and Productivity Evaluation: Track, monitor, and report quality and production performance to department supervisors and team members for educational purposes.
  2. Process Improvement: Review ongoing processes to increase knowledge of insurance billing, aging, denials requirements, and changes. Communicate escalated billing issues or trends to the billing management team based on audit results and/or awareness of payor or process changes.
  3. Internal Audits and Quality Controls: Ensure that internal audits and quality controls are in place in accordance with departmental policies, procedures, generally accepted accounting practices, and all applicable laws and regulations. Update and maintain memos, training manuals, and Revenue Standard Operating Procedures as needed in Master Control.
  4. Training and Development: Educate, train, and share knowledge with team members of all changes and system updates. Ensure training methods provided for both current and new staff members align with individual employee learning needs and result in Revenue staff members being able to demonstrate the required competencies necessary to complete the essential job functions for the role.
  5. Administrative Support: Process, respond to, or post correspondence, administrative requests, adjustments, transactions, and/or billing-related requests as required and in a timely manner in accordance with departmental policies, procedures, and performance goals.
Requirements
  • Education: High School diploma or equivalent.
  • Experience: Three (3) years' of related experience in medical billing or in a healthcare setting.
  • Knowledge and Skills: Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payer guidelines. Excellent communication, comprehension, and organizational skills. Exceptional ability to provide constructive feedback to employees.
Preferred Qualifications
  • Additional Education and/or Experience: Additional related education and/or experience.
  • Extensive Knowledge of Clinical Laboratory Operations: Extensive knowledge of clinical laboratory operations.
  • ICD-10 Coding Certification: Extensive knowledge of ICD-10 coding as demonstrated by obtaining an American Academy of Professional Coders (AAPC) certificate, or by having successfully passed the Sonora Quest Laboratories ICD-10 certified coding examination.