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MEDICAL QUALITY ASSURANCE SPECIALIST/FULL TIME
Perform compliance audits, risk assessments and investigations as it relates to billing, coding and reimbursement compliance. Study, evaluate and assess standards of operations, product process specs and other related issues to ensure QA standards. Develop, monitor and track QA data and process improvements in all services. Regularly monitor potential billing problems and billing errors. Assist supervisors in developing corrective action plans to improve billing activities and work flow.
High School diploma or equivalent
• Prefer 3-5 years of experience in multi-specialty physician billing • Background in medical auditing of physician billing is a plus • Able to learn quickly, be motivated, flexible, dependable, and comfortable to work independently as well as part of a team • Must have very good verbal and written communication skills to ensure positive and effective communication between auditor, supervisors and other employees • Detail-oriented with the ability to handle and prioritize multiple tasks and follow through to completion in a timely and accurate manner, with a commitment to excellence • Knowledge of medical terminology, ICD-9, ICD-10 and CPT codes • Must maintain strict patient and physician confidentiality to support protection of sensitive information, must follow all federal, state and hospital guidelines • Must maintain a current working knowledge of CPT and ICD-9 and ICD-10 coding principles, government regulations and protocols • Must be able to adjust to constant changes, and contribute to the improvement and advancement of new processes and procedures • Able to consistently demonstrate good time management, organization and analytical skills • Must possess a professional, positive and energetic demeanor that exhibits support of company goals and policies
Computer Skills Required
• Proficient PC skills including Microsoft Word, Excel, Outlook and Internet usage • Experience with medical software, databases, and electronic medical records
based on experience
• Conduct staff reviews to ensure billing accuracy and adherence to coding guidelines and insurance policies and procedures