Us Medical Claims Denials

Description The Quality Assurance Specialist/Subject Matter Expert (QAS/SME) is responsible for carrying out and implementing the quality review plan to ensure a high level of accuracy with the various job duties and actions of the different HIM processes. The QAS/SME will possess and maintain a high level of expertise in several sites, demonstrating an excellent understanding of the different guidelines.

Principal Responsibilities
Assist in the establishment of, implementation and maintenance of a formalized review process to ensure compliance with contractual agreements regarding accuracy rates.
Conduct daily reviews of 5% - 10% of all staff work in the various areas of specialization.
Upon finding any employee with critical error committed for the day, provide immediate feedback to the employee and corresponding increase in auditing of said staff’s work assignments to ensure continuation of the acceptable accuracy rate.
Develop audit reports for assigned clients tracking errors and discrepancies reporting to the QA Supervisor, Production Supervisor and HIM Support Services Manager.
When requested, perform the responsibilities of the staff as dictated by business need and work load.
Act as a mentor and role mode to staff in relation to professionalism, demeanor and work ethics.
Knowledge, understanding, and compliance with all Federal and Local laws and regulations regarding there area of expertise.
Knowledge of, understanding of, and compliance with all ARMCO policies and procedures.

Qualifications
Graduate of any Medical or Allied Medical course or has equivalent work experience.
Minimum of six months experience with exceptional performance in chosen area of quality management
Knowledge of general computer applications and ability to multitask on two monitors.
Quality monitoring and coaching experience preferred.
Extreme attention to detail required.
Ability to work in a team fostered environment and have the willingness to adjust to changing job responsibilities, shifting schedules, new procedures and unexpected workloads and stresses.
No outstanding breach violation for the past 12 months.