Quality Specialist

Quality Specialist

The Quality Specialist will play an essential role in reviewing and ensuring the quality of the Revenue Cycle teams' work efforts. The primary responsibility of this role is to perform independent account reviews that have been worked by our Revenue Cycle team members with the purpose of identifying opportunity and making recommendations for improvement to the operational and executive leaders.

Essential Job Functions :

• This role will assist Leadership with continued training, education and ongoing action plans to ensure quality is consistently met for existing teams in partnership with the Sr Quality Specialist and Leadership Team. In addition, this role will assist the Sr Quality Specialist and Leadership Team with onboarding support including user provisioning as required.
• Assesses the Quality Assurance process and actively looks for opportunities to increase efficiency and proactively brings to Leadership attention.
• Evaluate operational and management Quality Audit policies / procedures and provide input into the annual review workplan.
• Performs Quality reviews across multiple clients, working in a variety of host systems.
• Coordinate with service line leaders and partner with upper-level Leadership, to identify areas of risk and assist leadership in developing a quarterly / annual review plan.
• Develop a thorough understanding of business processes in scope for assigned reviews and document the processes.
• Perform account level review to ensure consistency with best practices including but not limited to Quality Audit to confirm implementation and effectiveness of policies / procedures.
• Perform reviews to measure compliance with policies, procedures, workflow, and other applicable requirements.
• Identify and document operational, compliance, and quality risks and make recommendations to mitigate risks.
• Prepare and assist in presenting quality reports of review findings and recommendations to direct leadership for review and approval.
• Participate in pre- & post-review meetings, providing support and recommendations for issues presented.
• Ensure past review recommendations are implemented in current review process.
• Maintain current knowledge of laws / regulations regarding medical necessity, clinical documentation, compliance standards, other general clinical and / or business matters related to the service line they are working.

Required Job Experience :

Required Education Level :

Required Certifications :