Revenue Cycle Quality Associate Analyst

Revenue Cycle Quality Associate Analyst ------------------------------------------------------------------------------------------------------------------------------------------------------- GENERAL OVERVIEW: The Revenue Cycle Quality Associate Analyst is responsible for performing comprehensive internal audits of revenue cycle activities, ensuring the accuracy and integrity of patient account data. This role involves conducting concurrent, prospective, and retrospective reviews of billing processes, follow-up procedures, payment posting, adjustments, and documentation. The Auditor ensures adherence to internal policies, external regulations, and industry best practices. The auditor will communicate audit findings and recommendations to improve processes, reduce risk, and optimize reimbursement. ESSENTIAL RESPONSIBILITIES • Routinely examines patient bills for accuracy and completeness, promptly identifying and reporting any discrepancies. Ensures strict adherence to all procedural guidelines in billing practices. Collaborates with medical billers and coders to resolve complex billing issues. Conducts thorough internal audits focused on enhancing billing efficiency and accuracy. Systematically prepares reports detailing billing activities, highlighting trends, and areas for improvement. Proactively identifies errors in billing records, such as incorrect coding or duplicate charges, and communicates these findings to relevant stakeholders to facilitate timely correction and process improvement.30% • Creates comprehensive audit summary spreadsheets and reports that analyze Revenue Cycle documentation, financial impact, and profitability. Delivers targeted education and training, or partners with internal and external resources, to present audit findings to department staff and stakeholders. 30% • Develops, delivers, and evaluates training programs and educational materials to address audit-identified deficiencies, ensuring adherence to regulatory requirements. Provides clear, written guidance to support audit processes. Collaborates with management to assess external audit findings, contributing to the development and implementation of appropriate responses. Actively participates in meetings, offering expertise on new programs, follow-up procedures, and the identification of ongoing educational needs. 20% • Performs routine audits to ensure billing practices are compliant with both industry standards and legal mandates. Delivers targeted training and continuous guidance to medical billing staff, proactively minimizing future errors and enhancing overall accuracy. 10% • Performs other duties as assigned or required, such as onboarding and mentoring new team members, conducting audits and research for special projects.10% • Other duties as assigned or requested. QUALIFICATIONS: Required • High School/GED • 2 years of Experience in the medical billing or related field. • Demonstrated ability to effectively perform liaison function with internal departments and external agencies or departments • Proficient in Microsoft Office applications, including Excel, Word, PowerPoint, Teams, Outlook • Experience operating PC and using software applications Preferred • Associates Degree • Billing certification, associate’s degree or completion of college level coursework • Working knowledge of financial procedures, healthcare/third party regulations, and/or billing requirements SKILLS: • Strong knowledge of billing and revenue cycle systems to accurately audit and assess the correctness of billing procedures. • Excellent analytical and critical thinking skills to identify discrepancies and errors in billing data and documentation. • Detail-oriented approach to ensure thorough examination of complex medical records and billing information. • Strong communication skills to report findings, make recommendations, and educate staff about correct procedures and policies. • Proficient in using billing software and other computer systems to manage and organize data effectively (Epic). • Comprehensive understanding of healthcare laws, regulations, and standards to ensure adherence during the auditing process. • Good problem-solving skills to rectify identified issues and improve the overall billing process. • Compliance: Need to adhere to compliance policies and procedures. Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. ------------------------------------------------------------------------------------------------------------------------------------------------------- Grade : AH-08 ------------------------------------------------------------------------------------------------------------------------------------------------------- Pay Range Minimum: $20.12 Pay Range Maximum: $31.18 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. 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