Quality Assurance Coordinator

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Quality Assurance Coordinator Full Time Downey, CA, US 30+ days ago Requisition ID: 1006 Working with the Accounts Receivable, Customer Care, Sales and Finance Teams, the Audits & Quality Assurance (QA) Coordinator is responsible for post service review of patient medical records, team member transactions and productivity to ensure proper processing of orders, confirmation, billing and collections. The Audits & QA Coordinator is also responsible for preparing, drafting and submitting responses to various departments, management teams or auditing agencies on matters of quality adherence and medical review. Responsibilities & Duties: Performs daily Quality Assurance audits of our Customer Care, Accounts Receivable, and Confirmation Department. Provides Daily and Weekly Productivity and Quality Assurance Reports to Customer Care Department. Reviews patient medical records for services provided. Researches and documents steps taken and transactions processed by SuperCare Health teams. Researches and documents medical necessity and justification for services provided. Drafts requests and inquiries, as well as letters of medical necessity to different departments at SuperCare Health, audit entities, doctors, medical groups. Processes internal chart audits, reports findings and recommends improvements and changes. Receives, reviews, researches on, prepares and submits documentation in response to external audits. Prepares and submits documentation to all levels of appeals in response to unfavorable decisions by auditing agencies. Assists with patient and referral surveys and inquiries. All other appropriate tasks identified and assigned by the Audits & QA Supervisor or Manager. Required Experience/Knowledge Experience in Pharmacy and/or HME industry, specifically in billing, collections, documentation, customer service. Good understanding of Private and Government payers’ general billing and qualification tools and guidelines. Demonstrated ability to review patient medical records and determine morbidities, limitations and needs. Effective written and verbal communication skills, as well as knowledge of medical terminology such as diagnosis, procedures, conditions, etc. Knowledge of patient confidentiality and HIPAA compliance regulations. Excellent interpersonal and customer relationship skills with the ability to work in a very fast-paced environment, learn new concepts quickly and independently. Computer literate with very good knowledge of Office, medical billing software. Detail-oriented and must have analytical thinking. Preferred Experience/Education High School Diploma or GED. Trade or Technical Training in Healthcare, Bachelor’s degree or above. More than 2 years of experience in a related field. #J-18808-Ljbffr