Analyst-Quality Assurance Position Available In Shelby, Tennessee
Tallo's Job Summary: Quality Assurance Analysts at BMHCC System Services in Memphis, TN evaluate internal controls to ensure proper claims adjudication. Responsibilities include auditing revenue cycle activities, assessing risk, andmunicating findings to leadership. Candidates need 2 years of healthcare experience and knowledge of revenue cycle functions. High school diploma required, with an associates degree preferred. Understanding of managed care policies and revenue cycle processes necessary.
Job Description
Analyst-Quality Assurance
Job ID:
31819
Job Category:
Finance and Accounting
Work Type:
Full Time
Work Schedule:
Days
Department:
Denial Mitigation
Facility:
BMHCC System Services
Location:
Memphis, TN
Overview
Job Summary
Quality Assurance Analysts evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate adjudication of claims. This role requires thorough understanding of regulatory requirements, managed care contract terms, facility-specific internal guidelines, revenue integrity, billing, cash applications, payment variances and adjustment processing including federal and state regulations and guidelines.
Responsibilities
Conduct audits to determineanizational integrity of upstream, midstream and downstream revenue cycle activities that impact the adjustment processing of claims.
Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities and current volumes of adjustments.
Complete special AR projects to help liquidate key segments of Baptist aging AR
Review all timely filing adjustments to determine whether Baptist has exhausted all attempts to appeal and overturn timely filing denials.
Communicate audit results to hospital service departments and departmental leadership, and make rmendations for management corrective action.
Serve as institutional subject matter experts and authoritative resources on interpretation of contract language to ensure appropriate reimbursement by insurancepanies.
Performs scheduled and unscheduled independent audits of revenue integrity and business office activities.
Conducts routine retrospective and prospective account audits as directed by revenue cycle system director.
Assess internal and externalmunication of changes to bettermunicate across functional departments
Ads to the defined audit timeline and audit protocol standards; assists with development of the audit schedule; identifies services to be audited.
Annually identifies specific needs for self-development and implements a plan to achieve professional growth.
Applies consistent and standardizedpliance audit methodology for sample selection, scoring and benchmarking, development and reporting of findings and repayment calculations.
Prepares written reports of audit findings and rmendations and presents to specific business offices; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records
Participates in the development of the department long-term and short-term goals, objectives plans, policies and procedures.
Specifications
Experience
Minimum Required
2 years of experience in the healthcare industry with a working knowledge of hospital or physicians revenue cycle functions.
Preferred/Desired
Education
Minimum Required
High school diploma or equivalent
Preferred/Desired
Associates Degree related to health care or information technology
Training
Minimum Required
Understanding of industry-specific terminology; Managed Care policy manuals and contractual expected reimbursement
Preferred/Desired
Detailed knowledge of revenue cycle work streams and revenue flow; Revenue cycle process management; Moderate systems expertise; Moderate experience with facility and professional billing requirements
Special Skills
Minimum Required
Preferred/Desired
Licensure
Minimum Required
Preferred/Desired
