Quality Assurance Audit Analyst

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🕒 March 6

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ACU-Serve

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

Healthcare Insurance • Fintech • SaaS

ACU-Serve is a company that specializes in optimizing revenue cycles for healthcare providers, particularly in the HME (Home Medical Equipment) and DME (Durable Medical Equipment) sectors. They focus on increasing clean claims through strategic partnerships, innovative solutions, and advanced technology. ACU-Serve's comprehensive approach includes revenue cycle management, A/R collection services, and resupply for infusion pharmacy and complex rehabilitation services, ensuring swift and accurate payments while enhancing client education and operational efficiency.

📋 Description

• Perform quality reviews for both Pre-Pay and Post-Pay audits as well as the client’s orders prior to and/or confirmation, according to established guidelines, that assist management in monitoring the quality, consistency and effectiveness of business processes, procedures and related tools. • Follow defined audit processes in conducting quality reviews; • Keep current on new coding and billing guidelines, federal and state initiatives. Ensure the consistent use of current codes, correct information, documentation and departmental procedures by monitoring their use and identifying any deficiencies; • Prepare summaries for management of quality review results, including basic analysis of identified deficiencies. • Reduce quality related errors by making recommendations to increase the efficiency of operations. • Assist with policy, procedure development and implementation as it relates to the claim review processes. • Review coding variances including supporting documentation, review of old and new procedure codes, consult and collaborate Director of Compliance as necessary. • Prepare supporting documentation as necessary. • Based on audits and claims reviews, prepare supporting documentation requests for configuration changes to ensure that configuration mirrors provider contract. • Keep current on new coding and billing guidelines, federal and state initiatives. Educate other departments on new/changes to regulations as necessary. • Coordinate recoupment efforts with Director of Compliance due to billing errors and over payments. Respond to provider inquiries regarding recoupments in writing and/or verbally when necessary. • Perform departmental quality audits. • Produce and deliver monthly a summary report of changes to the Director of Compliance; include relevant source documents.

🎯 Requirements

• Durable Medical Equipment experience is required • Must have knowledge of payor requirements for billing, auditing, and/or contracting with a strong background of Medicare LCD requirements • Excellent written and verbal communication skills • Must have knowledge of word, excel, and power point • Demonstrated ability to develop strong business partnerships and relationships with payors • Work closely with other internal customers.

🏖️ Benefits

• ACU-Serve is an equal opportunity employer and is committed to providing a workplace that is free of discrimination of all types and promotes diversity, inclusion, and respect. We prohibit discrimination and harassment of any kind based on race, color, sex, gender, religion, creed, sexual orientation, national origin, age, disability, genetic information, pregnancy, veteran status, or any other protected characteristic as outlined by federal, state, or local laws.