RCM Quality & Audit Specialist

The RCM Quality & Audit Specialist is responsible for ensuring the accuracy, efficiency, and compliance of the organization's revenue cycle processes. This role involves conducting audits, monitoring key performance indicators, identifying process improvements, and ensuring compliance with industry standards and regulations. his includes, but is not limited to claims, denial management, and functions for both onshore and offshore resources. The ideal candidate will have a strong background in medical billing, coding, and accounts receivable, with a focus on quality assurance and process auditing.

Primary Job Duties:

• Conduct quality reviews, audit revenue cycle claims and workflows against established standard operating procedures (SOPs)
• Develop, collect, analyze, report and measure multiple quality improvement initiatives that supports RCM operational functions
• Create and maintain quality measurements to track improvements in individual and team performance scores
• Identify potential deficiencies in processes via analysis and trends
• Create reports and deliver assessment/evaluation results to appropriate levels of leadership
• Research and identify the “root cause analysis” in process improvement (e.g. Ability to identify when a function/action was performed that is not included in the SOP or documentation available) and utilize audit findings to report trends and recommended training
• Assist with establishing, updating and communicating new and existing procedures
• Analyze and measure results of implemented policies and changes
• Collaborate with various RCM Leaders and internal partners to ensure goals are being met
• Serve as a SME on all RCM workflows that are being audited
• Participate in special projects, audits and process improvements in support of quality assurance initiatives
• Other duties, as assigned i.e. coordinate and serve as supplemental support to the National Training Team

• Associate’s or bachelor’s degree preferred
• Experience with statistical analysis preferred
• 3+ years experience in an auditing/QA role or equivalent RCM job related experience
• 2+ years experience with athenaHeath and/or athenaOne preferred
• Advanced working knowledge of Google Suite: Sheets, Slides and Forms
• Advanced Excel skills to include the ability to use formulas to analyze data, create graphs and pivot tables
• Experience managing data located in multiple software systems
• Experience documenting clearly defined processes, standard operating procedures and policies
• Demonstrates effective written and verbal communication skills with the ability to self-edit
• Must demonstrate strong interpersonal skills to interact positively and effectively
• Ability to work in a very fast-paced and changing work environment
• Must comply with HIPAA rules and regulations
• Collaborative, customer-focused and able to create visible value
• Ability to prioritize tasks, use sound judgment, and remain organized
• Strong attention to detail and time management skills
• Ability to accept constructive feedback and work towards self-improvement and professional growth

The salary range for this role is $65,000.00-$70,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.