Quality Assurance Specialist WFH in Austin, TX at Parallon

Date Posted: 3/8/2018

Job Snapshot

Job Description

QA Specialist

QA Specialist Job Functions

  • Audit all front end returns (Houston and South Texas Regions) in queue on a daily basis  
  • Review all back end (South Texas Region) returns ensuring return is valid on a daily basis
  • Update and reconcile two “Hearing Level” reports and submit to RCA on the 1st business day of every month. This to include updating PME on any RCA updates and new referrals
  • Submit a field visit report to RCA on a weekly basis to include keeping track of results. As well as  any SSC field visit requests on a as needed basis
  • Work closely with managers pertaining to any issue account including being available to representatives to supply direction on accounts and/or policy.
  • Track COBRA accounts marked for premium assistance to include being available to provide direction on COBRA processes. Premium assistance report to be submitted to corporate by the 3rd of every month
  • Work closely with Corporate QA on audits performed on any issue accounts on a as needed basis
  • Research program policy as it applies to account returns on a as needed basis   
  • Assist with any additional duties as assigned by manager 

Job Requirements

Knowledge: Working knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines. An understanding of patient confidentiality to protect the patient and the clinic/corporation.Extensive knowledge with program requirements and guidelines in order to effectively audit accounts for accuracy.

Experience: Minimum of 5-7 years with full knowledge of eligibility experience in the following programs:
1. Medicaid
2. Medicaid Aged & Disabled
3. Social Security
4. Victims of Crime

Hospital/medical business office experience with insurance procedures and patient interaction. Strong familiarity with a variety of the field's concepts, practices and procedures. College degree preferred or high school diploma (equivalent).

Competencies: Proficient experience with reporting. The position requires the QA Auditor to prepare, send, and receive reports for the Houston SSC Division. Demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly. Ability to collect, synthesize and research complex or diverse information. Exceptional customer service and the ability to plan organize and exercise sound judgment.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of responsibilities, duties and skills required.