RCM QA Specialist

The RCM Quality Assurance (QA) Specialist will be responsible for auditing the work of RCM analysts to ensure the highest standards of services are delivered. They will play a pivotal role in identifying process gaps and work closely with onshore and offshore teams to define SOPs and decision trees that will improve the process.

The Role:

• Apply quality assurance expertise by closely monitoring trends, identifying transactions and processes for audits, presenting audit outcomes and recommendations to mitigate gaps to the operations team for resolution.
• Utilize tools and technologies available to ensure quality concerns are proactively identified and corrected.
• Work closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters.
• Ensure Standard Operating Procedures (SOPs) and client specific practice instructions are followed and report any gaps identified with recommendations for improvement.
• Continuously improve the quality processes by suggesting innovative ways quality concerns can be quickly identified, fixed and monitored to avoid recurrence.
• Actively monitor for compliance as per HIPAA guidelines and report any incidence of non-compliance.
• Actively participate in quality and training huddles, create content, and deliver necessary training to resolve identified skill or knowledge gaps on the team.
• Audit for adherence to SOPs and other guidelines and provide references and feedback.
• Review customer feedback/concerns and ensure that corrective action is being taken, adhering to the plan of action.
• Provide feedback on SOPs so that the processes and procedures are created in such a way that these can be implemented most effectively.
• Propose changes in decision trees through which inefficiencies and redundancies can be eliminated.
• Participate and contribute to the success of new clients by identifying any bottlenecks during implementations.
• Provide training and guidance to team members to improve their knowledge and skills so they are sufficiently equipped to deliver best in class services.
• Collaborate with the onshore quality team to ensure consistency on processes and procedures being followed across Modmed locations.
• Perform additional projects and job duties as assigned.

Skills & Requirements:

• Bachelor's Degree -Bachelor’s preferably in Human Science / Commerce/ Business Administration preferred
• Certification in Quality Improvement and Assurance
• 5+ years of relevant working experience in core Provider RCM out of which minimum 2 years as SME, QA, QA Lead, etc. within a professional setting.
• Hands-on knowledge of the key functions within RCM is a must.
• Prior experience of working on Modmed products is a plus.
• Experience working on process improvements/ six sigma quality projects preferred.
• Proven knowledge of various insurance carriers, including Medicare, private HMOs, PPOs, Capitation and Workers’ Comp. etc.
• Advanced excel skills such as the ability to use formulas to analyze data, create and format pivot tables and templates, use and conditional formatting and validation functions, able to create visualizations of data through charts, graphs and powerpoint; able to manage information located in multiple software systems.
• Exceptional written, verbal, and interpersonal communication skills required.
• Committed to developing expertise in respective ModMed products (PM or gPM) within 3 months of employment.
• Professional demeanor, team player, strong time management skills required.
• Able to work during US night shifts within a hybrid work model from home and office is required - this position requires working closely with onshore/offshore teams, as well as with payer reps.