Qa specialist Jobs in Durham, NC

Duke Health Patient Revenue Management Organization

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions.

HYBRID POSITION: Monday - Friday

General Description of the Job Class:

Supervise and coordinate work assignments to Quality Assurance and Ambulatory Support staff. Maintain positive relationships with SAMs, supporting DUHS and PRMO's directive of meeting prescribed metrics. Prepare QA templates for monthly review. Develop and train staff, ensuring they have the necessary tools and knowledge to make meaningful contributions. Assist in the preparation of reports and analytics, identifying opportunities for enhancements through trends. Plan and conduct meetings with subordinates to ensure compliance with established practices to implement new policies and keep employees abreast of current changes and standards. Compile, analyze and report on QA performance of departmental operating units, noting trends and making recommendations or conclusions which are in alignment with the financial performance of the Health System. Review financial reporting and trends impacting reimbursements/cash projections (denials/write offs/performance dashboards); coordinate projects and quality assurance reviews based on trends; provide workflow recommendations for discovered deficiencies to improve reimbursement/cash projections. Track financial performance related to changes in workflow and/or recommendations.

Duties and Responsibilities:

Personnel (50%)

• Supervise and coordinate work assignments to Quality Assurance and Ambulatory Support staff.
• Assist in hiring, onboarding, training, and developing employees.
• Maintaining personnel files; remaining compliant with FMLA and pay and performance standards.
• Maintain attendance records, monitoring and approving PTO as well as maintaining and approving time in API.
• Communicate updates and changes in workflow to staff in an efficient and effective manner, exhibiting strong verbal and written communication skills.
• Monitor requirements for safety training, job specific trainings, and seek out opportunities for employee development.
• Conduct regular rounding conversations with staff to build connections through learning, caring, and sharing.

Workgroup / Clinic Liaison (30%)

• Build and maintain relationships with clinic SAMs, providing insight into the QA process and providing QA support to help clinic locations meet their financial benchmarks.
• Rounding with clinic locations that are underperforming in their QA reviews to gain insight into breaks in workflows, then partnering with SAMs and operational owners to remedy workflow issues.
• Track financial performance related to operational workflow changes to ensure positive financial results based on QA reviews.
• Participate in Service Access training opportunities to ensure up to date knowledge of system and workflow changes.
• Utilize front end registration knowledge to ensure accurate analysis of accounts reviewed.
• Assist in developing and defining short and long term departmental specific goals and objectives.

Reporting: (20%)

• Build QA templates each month for reimbursement specialist review.
• Identify, trend, and report problematic happenings that prevent Clinic Service Access locations from meeting their goals.
• Compile QA templates at the end of each month to clearly track and communicate to senior leadership the overall QA result.

General: (10%)

• Attends meetings and participates on committees, as assigned.
• Develop and provide job-specific training to new and existing employees within the department.
• Perform all other related duties incidental to the work described herein.
• Accomplish all tasks as appropriate.
• Living Duke's Values by demonstrating expected behaviors, contributing to a positive work environment.

Minimum Qualifications

Education

Work generally requires knowledge of clerical and accounting principles usually acquired through an associate degree in Accounting or a directly related field.

Experience

Work generally requires five years of progressive experience in an accounts receivable environment. A bachelor's degree in Accounting or directly related field may be substituted for the education requirement and 2 years experience. OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE