Quality Assurance/Training Manager Job in Newton 02420, Massachusetts US
OBJECTIVE:
The QA/Training Manager is responsible for assisting in the execution of one or more simultaneous client implementation training sessions, analysis of client and representative performance with appropriate action, process enhancement through QA/Training initiatives, claim revenue generation enhancement through process improvement, patient account quality assurance, and associate training initiatives. As a member of the organization’s management team, performance includes demonstration of the following accountabilities: excellent leadership, excellent communication and information sharing, mentoring, empowerment, influencing organizational change, and resource management. Excellent skills in medical billing and insurance recovery knowledge are absolute musts. Excellent curriculum development, research skills, and presentation skills are also musts.
RESPONSIBILITIES:
· Oversee QA/Training projects associated within the ClaimAssist business model, including but not limited to:
- Manage hospital reimbursement activities using defined tools and feedback mechanisms to successfully update management with claim activity. This might mean working with IT to build a Quality Assurance scorecard against a database for patient file and phone handling. Coordinate overall claim trends and business processes with operational management for any improvement needs. Recognize excellent performers.
- Report status to director on a regular basis and executive staff on an as-needed basis.
- Research national medical billing changes (non-Medicare) and state changes with Motor Vehicle and Worker’s Compensation fee schedule and statute changes. Internet research, state insurance department communication, insurance carrier communication, and universal information sharing are musts. Updating existing materials for accuracy and clarity are critical tasks.
- Build a ClaimAssist University on our internal intranet with courses, tutorials, and process changes.
- Conduct classroom sessions for leaders and front-line staff.
- Send newsletters to the staff.
- Monitor reports to confirm accounts are handled correctly and clearly defined in the process flow documentation.
- Maintain and continue the evolution of our corporate Quality Assurance program, including auditing of recorded calls for customer service, live files for patient account handling, and pre-closed files before returning to our clients. Build a QA staff around these critical initiatives.
- Identify, evaluate, and provide recommendations for automation and revenue enhancement opportunities. This includes software enhancements and possibly assisting in new technical initiatives
- Develop, maintain, and review comprehensive daily, weekly, monthly, and quarterly management reports using Microsoft Excel to provide analysis to directors and executive managers as needed.
· Identify areas of business need – work with QA Auditors and Trainer(s) to develop new curriculum and desktop materials to address job competency needs on an ongoing, continual basis.
· Manage Trainer, QA personnel directly. Lead and develop staff to fullest degree.
· Develop and maintain Standard Operating Procedures as new and continuing initiatives arise.
· Contribute to the department’s operational excellence and deliver quality services in accordance with applicable procedures, policies, and professional standards.
· Infrequent local travel may be required, and may change as new initiatives and business needs develop over time.
QUALIFICATIONS:
· 5-10+ years of analytic experience with either hospital data or insurance data
· Superior communication skills
· Leadership experience, with excellent recruitment skills to develop a robust QA/Training department
· Excellent computer skills, and specific proficiencies with Microsoft Excel and PowerPoint
· Excellent understanding of medical billing, especially liability-based billing, such as Motor Vehicle and Worker’s Compensation billing. Basic understanding of medical coding is very helpful.
· Ability to quickly learn new software applications
· Strong knowledge of hospital revenue cycle principles
· Demonstrated ability to develop detailed analytical models
· Change management skills – communicating changes universally is an absolute must
· Ability to develop, critique, and administer training materials
· Ability to develop and maintain Quality Assurance methodologies
· Coachability: Being receptive to feedback, willing to learn, embracing continuous improvement and being receptive and responsive to change
EDUCATION:
College Degree required. RHIT or RHIA certification a plus, but not a requirement.
~EOE~