quality assurance billing and record reviewer - Bakersfield, United States - Integrated Practice Management LLC

Integrated Practice Management LLC Bakersfield, United States

3 weeks ago

Description

Job Description

Job DescriptionDescription:

Job Summary:

Premier Valley Medical Group is seeking a detail-oriented and experienced Quality Assurance Billing and Records Reviewer to join our Specialty Programs team and various departments. The ideal candidate will play a crucial role in ensuring the accuracy, compliance, and quality of billing processes and medical records for our specialty programs. The Quality Assurance Billing and Records Reviewer will collaborate with various departments and external partners to identify discrepancies, implement corrective actions, and uphold the highest standards of billing and record-keeping practices.

Key Responsibilities:

Conduct thorough and systematic reviews of billing documentation and medical records related to specialty programs to ensure accuracy, completeness, and compliance with regulatory guidelines and internal policies.
Collaborate with billing, coding, and clinical teams to resolve discrepancies and inconsistencies in billing documentation and medical records.
Identify trends and patterns in billing and documentation errors, providing insights to leadership to implement process improvements.
Perform audits and spot checks on coding accuracy, diagnosis documentation, and procedure documentation in accordance with industry standards.
Verify that all billing practices align with insurance requirements, CPT and ICD-10 coding guidelines, and other relevant regulations.
Assist in the development and implementation of training programs for billing and clinical staff to improve documentation accuracy and quality.
Generate reports and summaries on audit findings, trends, and improvement initiatives for presentation to management.
Participate in cross-functional teams aimed at enhancing billing and documentation processes, ensuring seamless coordination between various departments.
Collaborates with third-party billing team to ensure claims are submitted appropriately and timely.
Collaborate with the IT department to utilize technology tools and software to streamline documentation and billing processes.
Provide guidance and support during external audits or reviews, ensuring accurate responses and compliance with audit requests.
Maximizes billing so that full reimbursement for services is received within the required timeline regularly with the different programs.
Trains staff involved in billing for each of the specialty programs.
Meets with program staff including providers, case managers, and medical assistants to provide technical support with regards to billing procedures.
Coordinates with program staff to ensure Billing documentation requirements take place.
Oversees billing rejections from funder to ensure billers correct in appropriate and timely manner.
Uphold patient confidentiality and data security protocols while handling sensitive medical information.

Requirements:

Bachelor's degree in Healthcare Administration, Health Information Management, or a related field (preferred). And/or experience (2+ years) in medical billing, coding, medical records review, or quality assurance within a healthcare setting.
Strong analytical skills with the ability to identify patterns, trends, and anomalies in documentation and billing data.
Excellent attention to detail and a commitment to maintaining the highest standards of accuracy and compliance.
Effective communication skills, both written and verbal, with the ability to collaborate across departments and convey complex information clearly.
Proficiency in using electronic health record (EHR) systems, billing software, and other relevant technology tools.
Demonstrated ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Knowledge of healthcare regulations, including HIPAA and other relevant compliance standards.
Strong problem-solving skills and the ability to think critically to identify root causes and propose effective solutions.
High ethical standards and a commitment to maintaining patient confidentiality.

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