Description:
The Quality Assurance (QA) and Compliance Manager in a medical billing company plays a critical role in ensuring the quality and compliance of production processes, billing practices, and employee performance. They are responsible for conducting daily QA checks, performing audits, and implementing measures to maintain high standards and regulatory compliance.
Key Responsibilities:
Quality Assurance (QA) Management:
- Conduct daily QA checks on production and Accounts Receivable (AR) teams to ensure accuracy, efficiency, and adherence to company standards.
- Identify areas for improvement, provide feedback to teams, and implement corrective actions as necessary.
- Develop and maintain QA protocols, checklists, and guidelines to standardise processes and improve performance.
Compliance Monitoring:
- Monitor compliance with billing regulations, coding standards (ICD-10, CPT), and healthcare industry guidelines.
- Conduct audits of employee practices, client billing, and documentation to ensure adherence to legal and ethical standards.
- Stay updated with regulatory changes, communicate compliance requirements to teams, and implement compliance training programs.
Auditing and Reporting:
- Perform audits of employees, clients, and billing practices to identify errors, discrepancies, and areas of non-compliance.
- Generate audit reports, analyze findings, and recommend corrective actions to address identified issues.
- Prepare compliance reports, metrics, and presentations for management review and decision-making.
Training and Development:
- Provide training and guidance to employees on QA standards, compliance policies, and best practices.
- Conduct regular training sessions, workshops, and coaching sessions to improve team performance and compliance awareness.
Documentation and Record Keeping:
- Maintain accurate records of QA activities, audit results, compliance documentation, and corrective actions taken.
- Ensure documentation is organized, up-to-date, and accessible for audits, reviews, and regulatory inspections.
Qualifications and Skills:
- Bachelor's degree in Healthcare Administration, Business Management, or related field. Master's degree or certification in Quality Assurance or Compliance is a plus.
- Proven 4+ years of experience in quality assurance, compliance management, and audits in the medical billing or healthcare industry.
- In-depth knowledge of billing regulations, coding systems (ICD-10, CPT), and healthcare compliance standards (HIPAA, CMS guidelines).
- Strong analytical skills, attention to detail, and ability to interpret complex regulatory requirements.
- Excellent communication skills, both verbal and written, with the ability to collaborate effectively with cross-functional teams and external stakeholders.
- Leadership qualities, including the ability to lead and motivate teams, drive process improvements, and ensure regulatory compliance.
- Proficiency in using auditing tools, compliance software, and Microsoft Office Suite for documentation and reporting purposes.