Revenue Cycle Training and Quality Specialist

Schedule: FT, M-F 8-4:30 

At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
The CBO Quality Assurance Analyst provides assistance with ongoing education, training and monitoring of Central Billing Office staff. Completes audits on work that involves charge entry, registration, billing, collection/follow-up, payments, refunds, denials, or handles customer service functions. Works to enhance and support departmental goals.

Essential Functions

• Performs audits on CBO staff members for accuracy and compliance to department policies and procedures, and industry practices. Creates and updates Employee Reports on QA activities * Evaluates common errors and system limitations and reports timely to Supervisor/Manager of user. * Collaborates with Technical Trainer to create tip sheets for all staff members to help eliminate common errors or to address the work around processes for system limitations. * Develops error tracking system from data identified by CBO leadership for use in scoring individual employees. * Provides timely feedback on QA activities to employees' supervisors. * Collaborates with CBO leadership, providers, and front line staff in enhancing and supporting department goals for increased performance and customer satisfaction. * Responsible for providing industry metrics on productivity standards and establishes quality assurance protocols. * Assists operations management with training needs, coordinating enhancements or needs assessments that are consistent with department policies and procedures. * Works collaboratively with CBO leadership in the development of PI for those staff members that do not meet the minimum requirements on the individual QA scores. * Participates in performance improvement through assisting with the implementation of policies and procedures, productivity standards, planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, tasks forces, cross-functional groups, projects and discussion with hospital and medical staff as observed by supervisor. * Demonstrates thorough knowledge of patient accounting/physician billing, and quality monitors while maintaining comprehensive knowledge of 3rd party billing requirements and reimbursement principles. * Participates in the validation of IT applications with implementation resources to assure understanding of application functionality and workflow for optimal QA evaluation.
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or GED equivalent Required and
• Associate's Degree in Billing, Coding, Business, Finance, or related field Required

Experience Qualifications

• Equivalent of 2 years of experience working with commercial, government billing or reimbursement processes may be substituted for education. Required and
• Minimum 3 years experience in healthcare administration, healthcare management, or related field Required and
• Minimum 2 years experience training Preferred

Skills and Abilities

• Knowledge of hospital and professional billing, and reimbursement requirements, and standard practice.
• Knowledge of CPT, HCPCS and revenue codes and their effect on reimbursement.
• Ability to communicate effectively both verbally and in writing.
• Basic knowledge of the concept of managed care and payor reimbursement methodologies
• Ability to effectively present standard presentations, and developing new methods and procedures.
• Intermediate Microsoft Office Skills: Excel, Word, Visio, PowerPoint.
• Excellent interpersonal skills with attention to detail and ability to organize, interpret, and present data.
• Organized, self-motivated and able to work independently of direct supervision to carry out responsibilities.
• Ability to provide a pleasant and welcoming appearance to all with which you come in contact and proven ability to work effectively with others.

Children's is the very best for kids and the very best for your career At Children's, we put YOU first so together, we can improve the life of every child