Quality Assurance Analyst

Position Overview: 

USPI is seeking a Quality Assurance Analyst to support analytics and reporting for the Surgical Hospital Revenue Cycle Management (RCM) team.  This role works closely with the Patient Access Manager and Director to drive data-informed operational improvements. As a key member of the Centralized Verification of Benefits team, the Analyst will ensure accuracy and efficiency in revenue cycle processes through audits, data analysis, and performance feedback.

Key Responsibilities:

·    Completes quality audits to ensure RCM employees are providing the highest quality of work. 

• Evaluate data quality, reconcile multiple data sources, and relay results to Leadership team in a clear, actionable manner.
• Provide monthly/quarterly/yearly feedback used to enhance overall performance objectives including Key Performance Indicators (KPI).
• Participate in documenting workflows, processes, and policies, prioritizing potential solutions to system or performance issues.
• Assist in establishing, updating, and communicating new and existing systems, workflows, policies, and procedures.
• Accountable for analyzing and measuring results of implemented policies, changes, and system modifications.
• Manages various queues for all items escalated for additional review. This includes claim denial data related to insurance verification, authorizations, medical necessity, etc.
• Additional duties as assigned

Qualifications:

• Significant three plus (3+) years’ experience with RCM management in a healthcare related industry with Ambulatory Surgical Center or Hospital experience preferred.
• Understanding of Revenue Cycle Processes, cause and effect on A/R and cash results.
•  Ability to analyze data and develop training content to disseminate.
• Ability to lead, manage projects and staff to achieve goals.
•  Understanding of system and business processes, as well as healthcare financial issues.
• Experienced in examining and reengineering operations and procedures.  Able to identify and implement solutions.
• Required to meet critical deadlines.
• Desire to motivate, inspire positive outcomes and deliver excellent results.
• Sound judgement and strong skills with respect to interpersonal relations, critical thinking, problem solving and analysis.
• The ability to communicate effectively, both verbally and in writing, with internal and external clients.
• Be able to handle competing priorities while meeting or exceeding deadlines.
• Must be proficient in computer skills necessary to perform job duties and must have strong knowledge of computerized billing systems. Intermediate knowledge of Word, Excel, PowerPoint, Access, and Outlook.
• Must possess positive attitude to enhance a cooperative and energetic work environment.