Revenue Cycle Quality Specialist IV

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Position Overview

The Revenue Cycle Quality Specialist IV supports Exact Sciences Revenue Cycle with all order to cash teams to ensure processes are providing the highest quality outcomes. This position will review work performed and the processes involved by various functions of the order to cash areas to make sure that quality is measured and that compliance with Standard Operating Procedure is ensured. They collaborate with members of area Leadership and Training teams as necessary to identify opportunities for improvement through root cause evaluation and present reporting to aid in decision making. As duties require exposure to individual performance data and internal departmental processes; the maintenance of confidentiality is essential.

Essential Duties

including but not limited to the following:

• Responsible for assisting in the compilation of assignments, pulling samples and audits for Revenue Cycle employees and workflow processes, while being subject matter experts.
• Acts as an internal resource for team activities and questions.
• Assesses accuracy based upon Laboratory Standard Operating Procedure, Media Lab, work instructions located in the online documentation tool and the accuracy of the work instructions themselves.
• Records and maintains quality data for audited employees and targeted audit data through entry into the identified tools. Tracks performance at an individual employee, workflow processes at all the department levels.
• Conducts root cause evaluation on identified quality exception issues.
• Conducts follow-up audits on Corrective Actions and provides measure and reporting of effectiveness.
• Identifies and provides timely detail summary reporting of quality exception issues found in audits.
• Maintains Revenue Cycle Quality specific documentation and work instructions.
• Conducts meetings, coordinates weekly updates and presents data and findings to Leadership.
• Identifies and provides timely detail summary reporting of quality exception issues.
• Stays current with all relevant guidelines and policies for the Revenue Cycle teams serviced.
• Lean Six-sigma Yellow belt certification is required within the first six months in this position.
• Performs additional duties as assigned.
• Conduct all assigned job duties in a timely and productive manner.
• Maintain or exceed both quality and productivity goals, as defined by the department.
• Ensure compliance with all Exact Quality Management System, Standard Operating Procedures, and guidelines; including, but not limited to, Quality Policy and Code of Business Conduct and Ethics.
• Ability to communicate effectively both verbally and written, with all levels of staff.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Regular and reliable attendance.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90 % of a typical working day.
• You will be required to obtain certification and maintain certification with each New Version upgrade for Resolute Professional Billing with Epic Verona training course within the first 12 months of hire. Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement. Exact Sciences will make a reasonable accommodation available, if necessary, to assist an employee with a disability to satisfy this requirement.

Minimum Qualifications

• Associates degree in Business, Analytics, Healthcare, or related field; or High School Degree/General Education Diploma and 2 years of relevant experience in lieu of Associates degree.
• 2+ year of experience in a contact center, data entry, revenue cycle or quality research and auditing.
• 2+ years of experience in medical terminology, billing, claims, HIPAA Laws, and insurance processing.
• Extensive current knowledge of government, managed care, and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes.
• Extensive knowledge of EHR Order to Cash processes involving investigation and correction of accounts; including updates to patient demographics, financial, and guarantor information.
• Proficiency in multiple computer systems. including Microsoft Office Suite, Epic, and Onbase.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• 4+ years of experience in medical and insurance billing processes.
• 3+ years of experience in data entry, revenue cycle, or quality audits.
• Experience with Epic Resolute PB and Prelude applications.
• Medical billing certification.
• Subject Matter Expert knowledge of medical coding; including International Classification of Diseases (ICD-9) and (ICD-10), Coding Procedure Terminology (CPT), and HCPCS coding.
• ASC X12 (ANSI) claims adjustment, remark codes and plan benefits.
• Lean Six-sigma Green belt certification.

Salary Range:

Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage. Learn more about our benefits.

Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging. If you require an accommodation, please contact us here.

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We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, and any other status protected by applicable local, state, or federal law.

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