Title: Quality Review Coordinator
Job Summary:
Under the direction of the Coding and Compliance Manager, the Quality Review Coordinator will ensure all initial and ongoing audits are performed by the Quality Review Auditor – (Revenue and Clinical) for RCM, FOC, and Providers as required to meet State and Federal Guidelines.This position will provide educational assistance to staff, ensure accurate billing is followed in accordance with CMS guidelines.
Job Duties:
1. Ensure that all required employees receive a baseline audit within 90 days of employment with Omni Family Health. In addition, all employees will be scheduled to receive an ongoing audit monthly or quarterly depending on their initial baseline audit results. The QR Coordinator will provide and develop an action plans to ensure all employees are functioning at or above the 95th percentile. Perform follow-up visits within 72-hours of audit completion to communicate findings and prepare training where necessary to meet CMS guidelines and Federal requirements.
2. Assist with the completion of provider audits as necessary to meet scheduled timeframes. Support QR auditors as necessary with RCM and/or FOC audits. Maintains ongoing staff and provider education to maintain compliance.
3. Works with RCM and Operations Leadership to monitor audits of new and existing employees.
4. Ensures audit performed meet department standards for quality and compliance.
5. Ensures that all QR Auditors are performing 30, 60, and 90 audits and schedule required meetings to review and provide training to all staff as necessary.
6. Works with RCM Leadership to develop action plans for training and education.
7. Assist in other work-related duties as assigned by Coding and Compliance Manager.
Job Requirements:
1. Ability to work under pressure.
2. Ability to handle multi-functions.
3. Understanding of community-based organizations and the ability to demonstrate effective communication skills (verbal, nonverbal, written) with the medical/dental staff and Office Managers.
4. Ability to work proficiently and efficiently promptly.
5. Ability to problem-solve and make decisions consistent with organizational policies and procedures
6. Able to work independently, demonstrating effective initiative, follow-through, organizational skills
7. Knowledge of all-payer codes.
8. Knowledge of all programs offered by OFH.
9. Promotes and believes in OFH’s mission statement.
10. Ability to relate to the public regardless of ethnicity, religion and economic status.
Additional Duties:
1. HIPAA compliance - Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information confidential.
2. Compliance - Ensure compliance with all local, state, and federal regulations.
3. QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
4. IT - Required to learn and use the Electronic Health Record and Practice Electronic System) and its components. As required by the job functions and highlighted in the Policies and Procedures. These components include NextGen, PMS, QSI, and other electronic features, as they are developed and implemented, as applicable to the work environment.
5. All employees will participate in the Patient-Centered Health Home Model at Omni Family Health.
Qualifications, Education, and Experience:
1. High school graduate or GED with a minimum of (2) years’ experience in handling billing and account receivables in an FQHC or similar healthcare environment.
2. CPC, and/or CCS Certification Required
3. Minimum of two years billing and accounts receivable experience in a physician practice or community health environment
4. Minimum of three years physician coding experience in a multi-specialty environment
5. Maintain annual coding certification requirements
6. Working knowledge of coding rules, regulations, and third-party payer requirements preferred.
7. Must possess good customer service skills and professionalism to interact with internal and external customers, patients and staff.
8. Must possess detailed knowledge of health plans, managed care contracts, and eligibility requirements.
Responsible To: Coding and Compliance Manager
Classification: Full or Part-Time Position, Non-exempt
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