Quality Assurance Analyst
Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Position Overview
The Quality Assurance Analyst will be accountable for inputting daily productivity results and completing daily quality assurance reviews for RCM staff as requested by VP/Director of RCM. Analyst works with department leadership to ensure productivity and quality reviews are completed timely throughout month, providing final summary 5th business day of following month for each employee in RCM department. Analyst will maintain / update current quality scorecards for various revenue cycle teams and provide suggestions on improvement in quality standards providing trend analysis to Manager/Director.
The Quality Assurance Analyst will work in conjunction with RCM Manager/Director to identify opportunities for additional education/training. The Quality Assurance Analyst utilizes a variety of proprietary and external tools to research and review accounts worked by RCM staff. The Quality Assurance Analyst will be required to use multiple resources including payor portals, phone calls, EMR system to review various accounts.
Essential Duties and Responsibilities include the following and other duties that are assigned.
• Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies.
• Leverage available resources and systems (both internal and external) to analyze staff worked accounts. patient accounting information and take appropriate action for payment resolutions; document all activity in accordance with organizational and client policies.
• Contributes to development, implementation and maintains the processes, workflows and Policies and Procedures utilized by the QA Department. Assess opportunities to improve internal workflows; ensure best methods and tools are utilized
• Discuss results related productivity and quality assurance with appropriate management team; discusses coaching and development needs with management teams and partners.
• Helps to develop, maintain, and update documentation and reference manuals related to production and QA programs within department
• Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, staff members, etc.
• Assists management team by working collaboratively and professionally with operational staff
• Provides quality and productivity results at a level that meets departmental standards, timing as outlined by Director/VP
• Compile consistent reporting statistics to document team performance.
• Actively contribute to and achieve team performance of set Operational Goals and objectives.
• Analyze accounts with critical thinking; utilizes departmental DLP, process guides, policies to ensure staff are utilizing resources provided
• Other Duties as Assigned
Qualification Requirements : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Position requires constant mental alertness, attention to detail, and high degree of accuracy required in completing all assignments. Strong problem-solving skills. Smart, driven, exceptional work ethic. Must be able to:
• Be 100% self-sufficient when completing productivity and QA assessments, showing expertise and knowledge working independently, while utilizing critical thinking and a solution-oriented mindset. Can take initiative when needed to share trends with leadership
• Possess thorough understanding of physician billing, accounts receivable follow-up, charge entry, cash posting, eligibility and benefits, authorization, referrals, transaction review, adjustment posting, etc.
• Proven track record with working in QA analyst role
• Proven experience utilizing payer portals including but not limited to: Availity, NaviNet, Change, Waystar, and others.
• Must be accustomed to working in a productivity/quality-based environment
• Ability to efficiently work in a remote environment to include good time management skills and timely communication with co-workers.
• Required proficiency in the use of computers and computer software. Ability to use email and chat functions, navigate websites and portals, intermediate level of experience with spreadsheets, word processing and other required software applications.
• Strong written and verbal communication skills.
• Follow oral and written instructions and follow through on all assignments. Excellent organizational skills. Highly detailed-oriented. Ability to work well in a group setting and independently.
• Ability to prepare organized memoranda, spreadsheets, graphs, and correspondence
• Strong ability to work independently and as a team member with peers
• Fluent knowledge of entire revenue cycle process
Education and/or Experience:
• Must have had at least 2 years quality assurance experience in a physician office setting.
• General Knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology.
• Data analysis and interpretation of findings
• Must have a High School Diploma/GED
Language Skills : Ability to read, analyze, and interpret human service periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Excellent communication and interpersonal skills.
Mathematical Skills : Ability to calculate figures and amounts such as percentages, mean, mode and median ability to draw and interpret graphs.
Reasoning Ability : Ability to define problems, collect data, establish facts, and draw valid conclusions.
Physical Demands : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee occasionally lifts/carries paperwork, files, office supplies, up to 20 lbs., pushes/pulls exerting up to 5-10 lbs. force, opening doors, file drawers, pushing files in drawers, and kneeling/crouching and/or ability to reach lower file drawers, file stretching to store of retrieve materials. Specific vision abilities required by this job include close vision and the ability to adjust focus. Frequent sitting at desk or computer while typing, completing paperwork, or meeting with patients.
Work Environment : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
Normal office environment where there is no physical discomfort cue to temperature, dust, noise, and the like. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Medical Practices
Quality Assurance
Full-time