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Managed Care QA Auditor

4 months ago

Duluth, United States National Vision Full time
Job Description

National Vision is hiring a Managed Care QA Auditor to join our growing team  The role is responsible for providing ongoing feedback and education to Managed Care Reps (MCRs) regarding the accuracy and integrity of customer registration, data collection, billing and cash posting.

What Would You Do? The Specifics.

  • Under the general direction of the Managed Care Operations Director, oversees the daily review of the integrity of data entered into required fields of the SDS system by Managed Care Reps during the billing, collections, and posting process.
  • Selects a random sample (5-10%) of accounts to compare the information input with source documents for data accuracy and systematically records the results of their quality review for the purpose of providing feedback for focused review and strategic improvement of billing/collections/posting data collection.
  • Understands of the complexities of customer data collection and revenue capture in a changing environment of inter-institutional agreements and special group contracting relationships.
  • Collaborates with multiple areas to initiate and support center-wide process improvement standards and competency.
  • Functions as an information resource for internal customers inquiring about billing standards of performance (both content & systems resource).
  • Provides education and training related to appropriate insurance coverage selection to MCRs.

Qualifications

Work Experience

  • 4-6 years related experience and/or training or equivalent combination of education and experience (Required)

Education

  • High school, plus specialized schooling and/or on the job education in a specific skill area; E.G. data processing, clerical/administrative, equipment operation, etc.

Additional Skills

  • Learning management systems is preferred.
  • Working knowledge of medical terminology.
  • Experience with revenue cycle management is preferred
  • Comprehensive knowledge of all aspects of patient account reimbursement (claims payment, authorization process, etc.) is preferred.
  • Comprehensive knowledge of registration/admissions and master patient index protocols is a plus.


Additional Information

Taking Care of our People

We understand the importance of financial health and security, and because of that, we provide competitive compensation to all Associates. We also offer a comprehensive benefits package including health and dental insurance, 401k retirement savings with company match, flex spending account, paid personal time off, paid company holidays, parental leave, employee eyewear discount and much, much more. At National Vision, we strive to deliver opportunities for professional growth and long-term career fulfillment. We provide training programs, access to educational courses and pride ourselves on the ever-increasing amount of promotions from within.

We value and respect the unique and individual differences that everyone brings. We embrace all differences in matters of diversity, equity, and inclusion to create a place where people want to come, stay, and do their best work.

We are an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, veteran status, and other legally protected characteristics.