General Areas of Responsibility:

• Achieve or exceed department goals as defined by the department director
• Implements initiatives and strategies to reduce errors
• Draft quality assurance policies and procedures
• Interpret and implement quality assurance standards
• Evaluate adequacy of quality assurance standards
• Devise sampling procedures and directions for recording and reporting quality data
• Review the implementation and efficiency of quality systems
• Document internal audits and other quality assurance activities
• Investigate customer complaints and non-conformance issues
• Collect and compile statistical quality data
• Analyze data to identify areas for improvement in the quality system
• Develop, recommend and monitor corrective and preventive actions
• Prepare reports to communicate outcomes of quality activities
• Identify training needs and organize training interventions to meet quality standards
• Evaluate audit findings and implement appropriate corrective actions
• Assure ongoing compliance with quality and industry regulatory requirements

Required Knowledge, Skills and Abilities:

• Excellent working knowledge of insurance carriers’ payment regulations including various reimbursement schemes, coinsurance and deductibles, and contractual adjustments
• Knowledge of Medicare, managed care and commercial insurances
• Working knowledge of HIPAA regulations and compliance
• Knowledge of modifiers and their proper use required
• Works with payers to determine reasons for denials, corrects and reprocesses claims for payment in a timely manner
• Maintains relationships with insurance companies
• High attention to detail and the ability to multi-task
• Possess a working knowledge of Microsoft Outlook, Word, and Excel
• Strong verbal and written communication skills
• Data collection, management, and analysis
• Problem analysis and problem solving
• Ability to plan and organize
• Ability to make decisions
• Ability to work with multiple teams

Qualifications:

• Bachelors Degree
• Combination of education and industry experience may be considered in lieu of BS/BA

·         Certifications in Quality Auditor, Quality Engineer, Quality Improvement Associate, and/or Six Sigma a plus

• Quality inspection, auditing, and testing experience a plus
• Knowledge of tools, concepts and methodologies of QA
• Knowledge of relevant regulatory requirements
• Experience with implementation of corrective action programs
• Certified Professional Coder (CPC) a plus