• Quality Assurance Specialist

    Location US-FL-Maitland
    Job ID
    2018-2133
    Category
    Hidden (8718)
    Metro Area
    Orlando, FL
    Facility Name
    RCM Orlando
  • Overview

    U.S. Anesthesia Partners (USAP) is the largest single-specialty anesthesia practice in the country with over 4,000 clinical providers and associates.  By joining our team you will participate in a highly collaborative and dynamic environment.  As an organization we are mission focused on delivering the highest quality in patient care and you will be directly supporting our talented clinical team.  We extend this same commitment to quality to our associates and supply tools and resources that will ensure we win in the healthcare marketplace and support of USAP.

    We are proud of our inclusive people culture that supports our associates to perform at their best.  USAP is an equal opportunity employer.  Candidates with physician services or related health care experience is a plus. We offer a competitive benefits package. 

     

    Responsibilities

    POSITION SUMMARY:    The purpose of the Quality Assurance Specialist position is to help drive quality and productivity in the production of medical claims data and to assure both accuracy and timeliness in all CBO claims submissions.  The Quality Assurance Specialist will specifically focus on adherence to all USAP billing compliance policies and maintain strict oversight of governmental payer requirements.  This will be done through designed 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 prescribe training needs. The Quality Assurance Specialist will assist Management in routine reviews of policies and procedures and the implementation of improvement plans as needed.

     

    ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

    • Complete audit analysis and reports at the individual, department and division level based on defined position pathways and individual / department performance and quality metrics.
    • Identify specific individual and department training needs and opportunities for performance improvement through a defined audit analysis program and assist in ongoing process improvement opportunities through audit analysis.
    • Audit work in the Charge Entry, Payment Posting and Collections Departments to determine compliance with Policies and Procedures.
    • Assist in development and implementation of education programs based on identified quality or productivity issues.
    • Provide follow up review of policy changes and implementation of those changes into audit process and reporting.
    • Maintain current knowledge of Medicare, Medicaid, Work Comp guidelines and rules.
    • Assist with internal and external compliance audits, account reviews on an as-needed basis.
    • Work with process improvement team to improve quality and performance through process improvement initiatives.
    • Maintain strictest confidentiality.
    • Performs other duties, as assigned

     

     

    REPORTING TO THIS POSITION:   No direct reports

    Qualifications

    JOB REQUIREMENTS (Knowledge, Skills and Abilities):

    • Excellent verbal and written communication skills
    • Ability to prioritize work
    • Understanding of CPT/ASA, ICD-9/10, and HCPCS coding
    • In-depth knowledge of Medicare, Medicaid, Workers Compensation guidelines and requirement
    • In-depth knowledge of the MSI patient accounting system and report writing
    • In-depth knowledge of anesthesia billing
    • In-depth knowledge of chronic/acute pain billing
    • Detailed audit approach and methods for testing accuracy and compliance to defined billing guidelines
    • Analytical skills to summarize audit findings into statistically meaningful reports
    • Ability to work effectively and independently with staff, physicians, and external customers
    • Must have strong 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 minimal supervision.
    • Ability to read, write, and speak English

     

     

    EDUCATION/TRAINING/EXPERIENCE:

    • High School diploma or equivalent.  
    • Associate’s or bachelor’s degree in a business or health related field is preferred.
    • Must have minimum of 2 years billing or collections experience in the health care field.

     

     

    PHYSICAL REQUIREMENTS:

    • 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 lifting papers and boxes weighing up to 35 pounds occasionally
    • Requires dexterity to type at least 35 wpm.

     

    WORKING CONDITIONS (environment and safety):

    • Work performed in office environment
    • Involves frequent contact with professional staff and managed care organizations
    • Work may be stressful at times
    • Interaction with others is frequent with ability to hadle managing multple requests from co-workers and management

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