Quality Assurance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine delivery/shipping tickets and on-site orders to ensure compliance with accreditation and payer regulations prior to billing confirmation.

• Validate delivery/shipping tickets and on-site orders on a daily basis.

• Index confirmed tickets into the appropriate electronic medical record (EMR) system.

• Cultivate and sustain knowledge of current home medical equipment (HME) products and services.

• Input patient notes and updates into patient records accurately.

• Assess documentation for validity, completeness, and precision.

• Verify or acquire alternate contact information, delivery addresses, instructions, and phone numbers.

• Choose cost-effective delivery methods and document delivery expectations and requests.

• Identify trends in systems or processes to enhance efficiency and generate cost savings.

• Process, verify, and submit necessary documentation and orders.

• Conduct insurance verification procedures.

• Enter and review information in EMR, including authorizations and expiration dates.

• Relay insurance trends to leadership for strategic decision-making.

• Verify insurance carriers in the company database and request additions when necessary.

• Maintain and review documentation concerning insurance coverage and reimbursement.

• Liaise with sales, operations teams, and physicians to obtain supporting medical necessity documents.

• Report issues to the supervisor and coordinate the submission of required documentation.

• Assist in performance improvement initiatives related to billing and coding.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• One (1) year of relevant work experience in healthcare administration, finance, insurance customer service, claims, billing, call center, or management across any industry.

• For senior-level positions, two (2) years of related work experience and one (1) year of specific job experience is required.

• Specific job experience includes the tasks listed in a Medicare-certified HME, Diabetic, Pharmacy, or home medical supplies environment that consistently bills insurance.

• Proficiency in navigating multiple online EMR systems.

• Familiarity with HME products and services.

• Understanding of CMS or managed care payer billing guidelines.

• Capability to complete insurance verification and assess eligibility, coverage, co-insurances, and deductibles.

• Aptitude for accurately processing, verifying, and submitting documentation and orders.

• Ability to meet quality assurance standards and key performance metrics.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on teamwork and collaboration.