Medical Accounting Quality Assurance Coordinator

The Quality Assurance Coordinator is responsible for all quality review on assigned accounts from the management team.  The core responsibilities of a Quality Assurance Coordinator include research, development of strategic plans for improvements in all areas of operations within the organization including leading and directing process improvement activities that provide more efficient and streamlined workflow for all areas of operation.  The person in this position will be responsible for monitoring of calls, accounts, strategies and/or process flows.  This position requires the ability to present results of improvements efforts and ongoing performance measures of processes within the organization to all levels of management.  This position requires the ability to work independently, accomplish goals, excellent customer service and communication skills, creativity, patience and flexibility.  Quality Assurance Coordinators rely on guidelines established by the organization to perform job functions and work under minimum supervision in a moderately fast paced environment.  The Quality Assurance Coordinator usually reports to the training department lead or supervisor. 

EDUCATION AND WORK EXPERIENCE

High school diploma or equivalent.  A minimum of two years previous work experience as an Insurance or Customer Service Representative is required.  Applicant must have full understanding of the operations processes of the organization, quality review processes of the functions within the organization (i.e. Customer Service, Billing, Collections, Managed Care, Medicare, Medicaid and Commercial Practices), and well-developed interpersonal skills.

REQUIRED JOB KNOWLEDGE AND SKILLSExcellent verbal and written communication skillsReliable attendance recordKnowledge of EOBs, CPT and ICD9 Codes, HCFAs, UB92s, HCPCS, DRGs and authorizations / referralsGood problem solving skillsAbility to learn / stay abreast of relevant policiesComputer literate / able to use basic functions of a computerAbility to type a minimum of 40 wpmDetail oriented and well-organizedOutstanding listening skillsAbility to perform under pressure in a calm mannerBasic math skillsHigh degree of accuracyPositive attitudeFlexibleTeam playerMentoring / Leadership

CORE RESPONSIBILITIES AND JOB FUNCTIONSReview and interpret all follow-up / collection activity for all areas of operationsReview and interpret contractual terms for Managed Care, Commercial, Medicare, Medicaid and Workers’ CompensationTrack and determine appropriate supporting documentation for all follow-up / collection activityAssist and resolve patient inquiries / requests in a 24-hour periodAssist with the development of Training Materials and training of Operational Team MembersAssist with special projectsCall monitoring / account reviewCreation and maintenance of company Policies and Procedures