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- 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.
- 4-6 years related experience and/or training or equivalent combination of education and experience (Required)
- 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.
- 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.
Managed Care QA Auditor - Duluth, United States - National Vision
Description
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.
Qualifications
Work Experience
Education
Additional Skills