Overview

The purpose of the QA Specialist position is to provide key data needed to drive continuous improvements within the RCM teams. The QA Specialist will specifically focus on adherence to all USAP compliance policies. This will be done through process audits, written reports and analysis of the reports as needed. Work products and outputs will include detailed audits and reports to identify process and quality deficiencies, analysis and recommended plans of actions to improve audited processes, as well as to recommend training needs. The QA Specialist will assist Management in routine reviews of policies and procedures and the implementation of improvement plans as needed. This person has increased knowledge of role and a complete understanding of their work as it relates to the business and consistently meets productivity and quality measures; requires little to no oversight or supervision. This role is expected to maintain the highest level of confidentiality regarding auditing results.

Job Highlights

• Audit work in the RCM departments, including but not limited to, Billing, Cash Management, Accounts Receivable, Customer Service, Payor Contract Management, to ensure compliance with policies and procedures, expected system functionality usage, and departmental workflows
• Partner with colleagues to ensure all auditing needs are met
• Act as a Subject Matter Expert (SME) within the auditing team and both a national and regional level
• Complete user and workflow audits in a timely manner, enabling department leadership to use audit data to improve and drive positive changes
• Accurately record audit scores and defect data at the individual, department, regional and division level
• Identify specific individual and department training needs, and assist in ongoing process improvement opportunities through audit analysis
• Partner with the Education & Development department to assist in development and implementation of education programs based on identified quality issues
• Review of policy changes, and implementation of those changes, into audit process and reporting
• Maintain up-to-date knowledge of department specific workflows, processes and system configuration updates, by actively partnering with RCM leaders
• Provide feedback to the Education and Development team regarding training materials to ensure they are updated as needed
• Perform ad-hoc audits as needed
• Work with the Process Improvement departments to improve quality and performance through process improvement initiatives
• Maintain strictest confidentiality
• Participate in local and national QA meetings, and be an active player in achieving annual departmental goals
• Responsible for developing and facilitating monthly reports, including content used for executive summaries
• Perform audits on peers, locally and nationally, to drive continuous improvements within the QA teams
• Review QA team’s backlog of work, and self-assign work as needed
• Performs other duties, as assigned

Qualifications

• 
  Excellent verbal and written communication skills
• Ability to prioritize work
• Knowledge of anesthesia billing preferred
• Strong background in lifecycle of a claim, collection and billing knowledge is essential
• Experienced with Athena/IDX (formerly known as Centricity Business) or similar system is preferred
• Analytical skills to summarize audit findings into statistically meaningful reports
• Strong presentation and written skills
• Ability to work effectively and independently with RCM staff
• Must have keyboard skills with knowledge of Microsoft Word, Excel and PowerPoint
• Must have a pleasant disposition and high tolerance level for diverse views, varied skill levels, and positions
• Ability to work independently with little to no supervision
• Ability to adapt to a quick paced environment that may include changing priorities
• Willing and eager to assist team members in achieving overall department productivity requirements
• Strong time management skills
• Ability to read, write, and speak English

• High School diploma or equivalent
• Minimum 5 years working directly within RCM for a healthcare provider
• Minimum 3 year working in an RCM role where auditing is a primary responsibility

• 
  Requires prolonged sitting, some bending, stooping, and stretching
• Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator, and other office equipment
• Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
  Requires dexterity to type at least 35 wpm.

• Work performed in a home office environment
• Involves frequent remote contact with professional staff
• Work may be stressful at times
• Interaction with others is frequent and often disruptive

US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.