Revenue Cycle Quality Assurance Specialist

4 days ago


Phoenix, Arizona, United States Sonora Quest Full time
Job Title: Revenue Cycle Quality Assurance Specialist

Job Summary:

This role is responsible for identifying and evaluating quality and productivity for the Revenue Department. The successful candidate will demonstrate a strong understanding of denials, monitor complex adjustments, and evaluate team members' ability to meet satisfactory requirements of essential job functions.

Key Responsibilities:

  • Track, monitor, report, and provide feedback regarding quality and production performance to department supervisor and individual team members.
  • Review ongoing processes to increase knowledge of insurance billing, aging, denials requirements, and changes.
  • Ensure internal audits and quality controls are in place in accordance with departmental policies, procedures, and applicable laws and regulations.
  • Effectively communicate with employees verbally and in writing to address training or procedural questions.
  • Process, respond to, or post correspondence, administrative requests, adjustments, transactions, and/or billing-related requests as required and in a timely manner.

Requirements:

  • High School diploma or equivalent.
  • Three (3) years' of related experience in medical billing or in a healthcare setting.
  • 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 related education and/or experience.
  • Extensive knowledge of clinical laboratory operations.
  • Five (5) or more years' of related medical billing/insurance experience.
  • 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.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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