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- High School Diploma or GED equivalent required with a minimum of 2 years college courses taken
- Bachelor's degree preferred
- Consideration will be given to an appropriate combination of education/training and experience Experience
- 7 years healthcare revenue cycle experience preferably in an academic medical center environment
- 2 years supervisory or team lead experience in professional billing with registration/precertification experience preferred Knowledge, Skills, and Abilities
- Must be able to effectively work in a fast-paced environment and to analyze, quantify, and produce reports about quality assurance concerns.
- Must possess excellent verbal and written communication and writing skills, and be able to interact with professional and administrative personnel as needed, but must be disciplined enough to most often function autonomously.
- Must have strong leadership qualities and be a person of exceptional integrity.
- Must be able to make sound recommendations on issues that impact the MedStar Health enterprise and assist in the implementation of those recommendations.
- Skilled in the use of standard office equipment including, but not limited to computer, fax, copier, printers, and Microsoft Office software.
- Knowledge of the GE/IDX scheduling/registration system and/or other automated scheduling/registration system preferred.
- Skilled in the use of ACD Telecom tracking software at MedStar.
- Knowledge of medical terminology and insurance terminology required.
- Must possess a thorough knowledge of Windows Office applications (Word, Excel, Power Point, etc.).
- Ability to communicate effectively with Administrators, clinical associates and other MedStar Health associates.
- Ability to work in a high-pressure environment with time constraints while maintaining a professional demeanor.
- Must be able to remain calm and use diplomacy when dealing with stressful situations.
- Ability to work and thrive in team oriented, production and deadline driven work environment.
- Assists AVP in creating and maintaining comprehensive Policy and Procedure manuals for the 3 self pay-oriented units; includes ensuring all changes and business operational updates are discussed with leadership and communicated to the associates.
- Assists in preparation of the delinquent accounts as they are electronically transferred to the collection agency; to include a 2-day process of compiling all collection agency delinquent candidates and deceased patient accounts, and working with the Self Pay Supervisor to reconcile the totals to ensure accuracy in the dollar values and accounts transferred.
- Attends management meetings and communicates issues/resolutions for process improvements to AVP and other leaders. Develops appropriate reporting tools and trends areas of improvement for distribution to appropriate leadership. Discusses the findings of the audits, explain errors, provides specific retraining and proposes suggestions for future success, working both with staff and leaders.
- Ensures associates compliance with MPBS groups Collections Policies and Procedures.
- Ensures that operational efficiency and managerial cost-effectiveness occurs on a regular basis.
- Establishes and manages quality assurance project plans, resources, goals & schedules to support senior level administration initiatives. Specifically, monitors team's productivity and quality of work on a regular basis. Audits are aimed at oversight of system edits and making certain to verify proper registration and visit fsc string selection and sequence and timely resolution of various types of issues focusing on ensuring accuracy and timeliness of actions taken on GE/IDX and SMS (eCommerce, TES, GE Claim edits, Website Inquiries, Rapid Response call line, ETM Views Details & Report Safe and Collection Status reports). Oversees these multiple projects while adapting to changing priorities and concurrent deadlines.
- Exemplifies Guest and Associates Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds associates accountable for conformity with those standards in all activities.
- Keeps current with changes in healthcare systems, insurance industry and issues specific to the Billing and Registration initiatives in effect at MedStar Health.
- Manages patient correspondence ensuring proper team delegation and standards for turnaround. Includes working with leadership in other areas such as Payment Posting and records Management and PSS in order to ensure proper sorting and timely receipt and processing. Provides and maintains metrics so team leadership can easily know the status.
- Masters multiple healthcare systems, interfaces and various reports that are generated for managerial decision-making purposes, and provides on the spot assistance to staff with multiple types of issues or problems.
- Monitors Telecom ACD call center, assisting leadership in making sure patients are being quickly and properly serviced. Creates ACD phone traffic and phone personnel reports and reassigns staffing priorities in the absence of leader.
- Participates in educational/professional development activities.
- Plans and executes training sessions for self pay-oriented units. Focuses on error trends spotted during audits and updates staff on new procedures as well.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
- Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
- Performs other duties as assigned.
Quality Assurance Auditor - Arlington, United States - MEDSTAR HEALTH
Description
Remote position.
Ideal candidate will be local to the DMV area for future on-site training.
Sets benchmark standards for all the Self Pay-related units of MPBS: Customer Service, Post Arrival Insurance Recovery and Self Pay Collections. Provides centralized quality control by performing widespread sampling of all transaction types processed by the 3 units. Primarily independently develops, implements, and manages Quality Assurance Program initiatives and training seminars for the units. Samples teams work product with the intent of facilitating speedy corrections, retraining and improving processes. Ultimately supports and facilitates the teams goals of inputting accurate information so initial reimbursement attempts are successful. Produces regular reports with supporting documentation, which is distributed to team management and used as supporting information for process improvement and performance reviews. Requires occasional interaction with patients and their family members. Creates and/or updates audit policy manuals for the 3 units as well as training seminars to ensure that all users possess the appropriate knowledge and resource materials to reference when performing their assigned tasks.
Education