Hospital Quality Assurance Coordinator

USPI is looking for a RCM Quality Assurance Coordinator (QAC). The QAC is responsible for all Revenue Cycle Management (RCM) QA functions in support of the Hospital-CBO mission, vision and center goals. The Quality Assurance Coordinator develops an environment and culture that embraces continuous improvement and innovation to ensure USPI achieves best practice in all areas of the revenue cycle. Ensures the RCM department maximizes the collectability of the services performed. Ensures that policies and practices support operational quality, efficiency and compliance. Responsible for assisting and leading a variety of audit projects within the Revenue Cycle Management department. Working closely with the RCM Revenue Manager/Director to report findings and suggest improvements to internal processes by analyzing data.

Duties include, but are not limited to:

• Completes quality audits to ensure RCM employees are providing the highest quality of work
• Proactive communication with the RCM Manager/Director on practice data, issues and KPIs that are meaningful to our centers.
• Ensure claims are adjudicated in compliance with provider contract parameters, member demographic information, and service level requirements through random and targeted claim reviews
• Compile data, perform audit, interpret and report back results to management team
• Conducts Audit-the-Auditor claim audits for procedural and financial accuracy
• Provide monthly/quarterly/yearly feedback used for client report cards and company Key Performance Indicators (KPI)
• Participate in documenting and prioritizing potential solutions to issues & fallout for system issues
• Establish and implement interim workaround solutions as needed and communicates to all impacted users
• Assist in establishing, updating, communicating and training new and existing policy and procedures
• Accountable for analyzing and measuring results of implemented policies, changes and system modifications
• Ability to meet assigned deadline and work under minimal supervision and with all levels of staff and management

Required Skills

Required Experience

• Bachelor’s Degree in Business or Healthcare Administration preferred; or equivalent management background experience
• 8 years of previous Revenue Cycle Management, Ambulatory Surgical Centers and healthcare business processes preferred
• Knowledge of medical terminology, CPT codes, and ICD-10 codes preferred
• Expert level experience with Microsoft Office Products- ability to create and build spreadsheets and reports in Excel
• Demonstrates competence in leadership skills to develop and implement organizational strategies and opportunities for improving hospital growth
• Maintain current knowledge and adhere to appropriate regulatory standards such as Government
• Effective English communication skills, both written and verbal
• Project management and operational implementation skills are a must
• Advanced understanding of healthcare related federal, state, and health plan guidelines
• Computer technology proficiency, such as Word, Excel, Tableau and Outlook