Managed Services-BOS-Quality Control - Associate - Operate

Not Applicable Managed Services Associate A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology.

Our Revenue Cycle Managed Services team will provide you with the opportunity to act as an extension of our healthcare clients revenue cycle functions. We specialize in front, middle and back office revenue cycle functions for hospitals, medical groups, and other providers. We leverage our custom and automated workflow and quality assurance products to enable our clients to achieve better results, which ultimately allow them to provide better patient care.

• Medical collections (Medical Collections Specialist II preferred), billing and/or claims experience
• Customer service experience
• All payer knowledge required (government and non-government)

• Performs quality control audits; reviews and monitors accounts;
• Identifies problems, analyzes cause and effect, and suggests recommendations for improvement;
• Provides daily constructive feedback based on account notation;
• Identifies areas of weakness and communicates recommendations on changes and improvement to Continuous Improvement Specialists;
• Document findings of analysis. May prepare reports and suggests recommendations of implementation of new systems, procedures or organizational changes;
• Relies on specific instructions and pre-established guidelines to perform the functions of the job;
• Possesses ability to be confidential; Supports company compliance by demonstrating adherence to all relevant compliance policies and procedures; demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of sensitive information;
• Consults and collaborates with Continuous Improvement Specialist to identify and assess training needs based on work audited;
• Participate in quality control meetings;
• Possesses considerable leadership skills, fostering an atmosphere of trust; seeks diverse views to encourage improvement and innovation; coaches and develops staff through timely and meaningful written feedback;
• Possesses a cooperative and positive attitude toward management and co-workers by responding politely and professionally and being a valued team player; and,
• Exemplifies extensive knowledge of the hospital revenue cycle with specialization in healthcare billing, follow-up, and the account resolution process to include, but not limited to claims submission, acceptance, and adjudication, transaction reviews, adjustment posting, identification of patient responsibility, etc.

• Good analytical and math skills;
• Able to document problems and assist in their resolution;
• Demonstrated ability exceeding all established department/client quality and productivity standards;
• Proven ability to lead by example and foster mentoring relationships;
• Strong written and oral communication skills;
• Computer and internet literate in an MS Office environment; and,
• Ability to establish and maintain effective working relationships
• US Healthcare Commercial and Managed Care Insurance Claim Management/Billing/Claim Edit Resolution
• US Healthcare Medicare and Medicaid Insurance Claim Management/Billing/Claim Edit Resolution
• US Healthcare Denials Management (technical and clinical)
• US Healthcare Underpayment/Payment Variance Management

• Quality Assurance
• HIPAA Privacy and Security Regulations with payer knowledge
• Epic Resolute, HB and PB Patient Accounting
• Cerner RevElate Patient Accounting
• Meditech Patient Accounting

• High school diploma or GED required; Associates Degree preferred
• Additional Certifications Medical Billing Certification preferred

Degrees/Field of Study required Degrees/Field of Study preferred Accepting Feedback, Accepting Feedback, Active Listening, Automation Solutions, Business Process Improvement, Communication, Competitive Advantage, Cost Efficiency, Demand Management, Emerging Technologies, Emotional Regulation, Empathy, Inclusion, Intellectual Curiosity, Lean Process Improvement, Operating Model, Operational Analysis, Operational Excellence, Operational Support and Analysis, Operations Management, Operations Process Improvement, Operations Strategy, Operations Support, Optimism, Process Data Collection {+ 9 more} No November 26, 2024