Qureos Mentor

Brault

<div>Description:

Position Summary
The Quality Assurance Auditor is responsible for conducting detailed audits of all billing activities and accounts worked within the billing software system. This includes reviewing claim follow-up, collections efforts, resolution of denials, and special billing projects or programs. The auditor ensures compliance with internal protocols, payer regulations, and industry standards.
This role plays a critical part in identifying trends, ensuring accuracy, and improving the overall efficiency and effectiveness of the billing and collections process.
Essential Duties and Responsibilities<ul><li>
Audit daily work completed by billing staff, including claim submissions, follow-up activities, and collection efforts.</li><li>
Review account documentation, actions taken, and billing outcomes within the billing system to ensure accuracy, completeness, and compliance.</li><li>
Identify errors, discrepancies, and trends that may impact reimbursement, operational efficiency, or regulatory compliance.</li><li>
Provide detailed audit findings, feedback, and recommendations to billing staff and leadership to improve performance and accuracy.</li><li>
Monitor, address, and audit special projects (e.g., credit card chargebacks and high priority payer follow up) and programs (e.g., AB75) to ensure adherence to established billing protocols.</li><li>
Collaborate with team leads, supervisors, and managers to develop, implement, and refine policies, procedures, and workflows based on audit results.</li><li>
Assist with the training and education of staff on documentation standards, payer requirements, billing procedures, and industry best practices.</li><li>
Participate in quality assurance initiatives and prepare reports for leadership summarizing audit results, performance trends, and opportunities for improvement.</li><li>
Maintain current knowledge of industry regulations, payer policies, and billing software updates applicable to medical billing and accounts receivable.</li><li>
Support internal and external audit requests by gathering documentation, performing reviews, and responding to audit inquiries as needed.</li><li>
Perform manual tasks within Cross Workflow, including but not limited to AR Support Requests and AR Follow-Up Requests, while addressing high-priority emails from Patient Services related to invoices involving legal representation and time-sensitive deadlines.</li><li>
Conduct audits for compliance, as assigned or requested to ensure adherence to company policies, payer guidelines, and regulatory requirements.</li></ul>
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Requirements:

Knowledge, Skills, &amp; Abilities<ul><li>
Ability to work in a fast-paced environment while maintaining accuracy and focus</li><li>
Strong organizational skills to ensure deadlines are met</li><li>
Strong knowledge of medical billing and accounts receivable processes, including claim lifecycle, denials, and payer rules.</li><li>
Proficient in using billing software and electronic health record (EHR) systems.</li><li>
High attention to detail and accuracy in reviewing documentation and financial records.</li><li>
Analytical skills with the ability to detect patterns, discrepancies, and areas for improvement.</li><li>
Understanding and adhering to HIPAA and other government and healthcare industry regulations.</li><li>
Strong written and verbal communication skills to provide constructive feedback and report findings.</li><li>
Ability to work independently, manage multiple tasks, and prioritize responsibilities effectively.</li><li>
Extensive knowledge of insurance guidelines including Medicare and other government payers, private, self-insurance, and managed-care plans.</li><li>
Familiarity with auditing techniques and principles within a healthcare revenue cycle setting.</li><li>
Knowledge of MS Office including Outlook, Word and Excel</li><li>
Excellent verbal and written communication skills</li><li>
Excellent attention to detail and time management skills</li><li>
Excellent customer service skills.</li></ul>
Education &amp; Experience Requirements<ul><li>
High School Diploma</li><li>
Minimum 3-4 years revenue cycle experience</li></ul></div>

Accounts Receivable Quality Assurance Auditor

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Accounts Receivable Quality Assurance Auditor