Quality Assurance Specialist-(3304636) - Partners Healthcare System

The Opportunity

Reporting directly to and under the general direction of the Manager, the Quality Assurance Specialist (QAS) responsible for auditing services billed throughout the Revenue Cycle functions.

The QAS is responsible for the following;

• Completing regular audits within established time frames
• Summarizing and reporting audit results
• Recommending preventative actions when errors/issues are uncovered
• Recommending automation/work flow improvements
• Maintaining updated written documentation on all work flows
• Educating staff as directed by the Manager

The primary objective of the Quality Assurance Analyst is to ensure MGB RCO services meet or exceed the established quality standards. Duties include:

Quality

• Perform baseline and ongoing quality assessments of the revenue cycle against documented workflows/policies, and governmental and/or payer guidelines as appropriate.
  
• Monitor performance quality of PFS team and vendor partners.
  
• Conduct regular Quality Assurance (QA) calibration sessions to ensure consistency among evaluators and outside vendors
  
• Participate in regular calibration meetings with QA, Training, and Operations Leadership to ensure consistency of expectations, standards, and evaluations
  
• Proactively identify trends based on quality evaluations and provide program Operations Leadership with regular performance feedback.
  
• Document evaluations utilizing departmental quality monitoring templates, established quality standards, and quality monitoring technology.
  
• Regularly and accurately report findings to the Manager and/or user via the approved scoring, tracking, and reporting mechanisms.
  
• Take a lead role in continuous quality improvement efforts on an ongoing basis. Establish goals with Manager and track progress.

Training

• Utilize quality assurance activities to identify opportunities for additional training and/or enhancements to training materials and work collaboratively with internal and external teams to help provide education and training on these areas.

Reporting

• Assist with the development and delivery of regular reports on performance, trends, and other actionable insights to the QA, Training, and Operations Leadership teams.
  
• Work collaboratively with team to ensure that all reviews are accurate, and that the scoring and reporting of review results are done timely and accurately in accordance with approved reporting methods developed by the Quality Team and Management.
  
• Leverage Epic reports as well as quality monitoring applications to best meet the department's QA needs.
  
• Maintain a QA dashboard, ensuring the integrity of its data.

Knowledge

• Utilize electronic billing and medical retrieval systems as well as in depth knowledge of medical billing and insurance rules and regulations to identify and resolve accounts receivable issues.
  • Maintain a complete understanding of all department policies and procedures to execute all billing tasks with minimal direct supervision.
    
  • Working knowledge of insurance rules and regulations to interpret new insurance/HCFA/HIPAA information and report potential impact. Utilize experience to efficiently and effectively determine the correct course of action on each account/project.
• Maintains a working knowledge of changes to CMS/State billing guidelines or contract-specific payer guidelines to adjust training materials as required.
  
• Working knowledge of sensitive information/minimum necessary, rules of release, and redaction processes preferred.

General duties

• Maintain constructive, professional relations with outside vendors/partners in order to represent MGB Revenue Cycle effectively.
  
• Achieve excellence in performance by working collaboratively with others on MGB Revenue Cycle initiatives.
  
• Supports and demonstrates the values of Mass General Brigham by conducting activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.

Qualifications

• High School Diploma required
• Bachelor’s degree preferred
• 2 years Epic System experience required performing at a high level of proficiency and independence
• 2-5 years of billing/accounts receivable experience required in a high volume medical billing setting
• Detailed working knowledge of medical terminology, ICD 10 coding and CPT, HCPCS required
• Solid written and verbal communication skills essential
• Quality inspection, auditing, and testing experience preferred
• Solid understanding of the Revenue Cycle

Skills and Abilities

• Demonstrate proficiency with a variety of automations, including but not limited to Epic, Microsoft Word, Excel, Power Point, E-mail, and Payer Websites. Experience with a knowledge management tool preferred (SharePoint).
• Understanding of rejections and denials and their associated data elements.
• Organizational Ability/Attention to Detail - Ability to work independently on assigned tasks, including planning, organizing, problem solving, and meeting established deadlines. Ability to work well with several individuals/teams/projects simultaneously. Ability to prioritize work under time pressure. Follow-through and exceptional attention to detail on all project tasks is essential.
• Research Skills – Strong analytical skills and ability to thoroughly research topic areas needed for projects and integrate knowledge into training, QA, and Knowledge Management processes.
• Must be flexible, able to multitask, and function positively in a dynamic environment subject to impromptu changes in schedules and priorities.
• Ability to understand the work environment and competing priorities in conjunction with developing/meeting project goals.
• Strong interpersonal skills to interact positively and productively with a variety of personnel within the organization.
• Perform other duties as assigned.

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.