Job Summary
This position is responsible for conducting quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. The PBS Quality Assurance and Training Analyst will identify problems, analyzes cause and effect, and make recommendations for improvements. This position has analytical, and/or administrative responsibilities specific to the department. Responsible for auditing multiple PBS departments and department processes and involves specialized background or knowledge regarding claims processing rules relevant to the assignment. This position will oversee and implement quality improvement activities from trend reports and work closely with department leadership to identify training opportunities
Essential Functions and Responsibilities include the following:
- Conduct focused quality audits across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
- Document findings of analysis and prepare recommendations for implantation of new systems, procedures, or organizational changes to reduce errors.
- Identify areas of weakness and communicate recommendations on changes and improvements to training materials.
- Provide feedback to management on errors detected, ensures errors are resolved, and provides long-range solutions to causes.
- Develop and implement a quality control and improvement program based on targets identified through the quality reviews.
- Work with various department team members on processes and process improvements
- Conduct QA call reviews, agile requests and audits.
- Compile data, provides feedback, and generates reports for operations and/or training areas on quality performance.
- Develop and deliver targeted training materials to address specific performance gaps identified through quality assurance reviews.
- Schedule and conduct training sessions at request of Leadership.
- Create and update remedial training materials tailored to address specific issues identified in QA reviews
- Facilitate training sessions for billing staff, focusing on best practices, compliance, and operational efficiency.
- Other duties as assigned
Additional Job Requirements
- Regular scheduled attendance
- Indicate the percentage of time spent traveling - 10
Subject to applicable laws and Air Methods policies, regular attendance is an essential function of the position. All employees must follow Air Methods employment practices and policies.
Supervisory Responsibilities
This position has no supervisory responsibilities.
Qualifications
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. In accordance with applicable laws, Air Methods will provide reasonable accommodations that do not create an undue burden so disabled employees may perform the essential functions of the position.
Required Education:
- High School Diploma or general education degree (GED) and 5 to 8 years related experience and/or training; or equivalent combination of education and experience
- Bachelors degree (B.A. /B.S.) preferred.
Required Work Experience:
- 5-8 years of related claims processing, customer service, auditing, training, analysis, or operations experience.
- At least five (5) years of experience performing quality audits.
Skills
- Strong analytical and organizational skills
- Ability to be a team player with a positive attitude
- Ability to provide training, coaching and support to teammates
- Excellent written communication skills
- Excellent presentation skills: ability to present trends, findings, opportunities, etc. to all levels of the organization
- Accuracy and Precision
- Ability to multi-task and prioritize workload in a fast-paced environment
- Working knowledge of healthcare payment models, revenue cycle, payer contracting, claims life cycle
- Ability to work with multiple departments and understand the processes and workflow for each
- Ability to work independently with minimal direction.
- Ability to work closely with management and trainer to identify any training opportunities to remediate deficiencies found
- Ability to exercise discretion and judgment while auditing the work of others
Computer Skills
- Advanced in Microsoft Suite, including Word, Excel, PowerPoint, and Outlook.
Certificates, Licenses, Registrations
Note: This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position.
Air Methods is an EEO/AA employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.