Revenue Cycle Quality Assurance Specialist

Founded in 2006 Emergicon has grown into the largestemergency medical billing company in Texas serving fire departments and EMSagencies ranging from small rural operations to major Texas and Emergifire operate from a service-first culture built on hardwork accountability and kindness.

We are looking for an experienced Revenue Cycle Quality Assurance Specialist to join our this role youll serve as Emergicons dedicated quality checkon the revenue cycle auditing billing coding accounts receivable andpayment activity for accuracy completeness and compliance then tracking correctiveaction until problems stay fixed. This position also helps build the audittools scorecards and standards for Emergicons growing quality assuranceprogram.

This is a hybrid positionbased out of our Terrell TX office with remote work available in accordancewith company policy.

ESSENTIAL DUTIES ANDRESPONSIBILITIES

• Perform routine random targeted and risk-based audits of revenue cycle activity reviewing accounts for accuracy completeness timeliness documentation and adherence to established requirements
• Audit across the full claim lifecycle including patient demographics insurance and eligibility charge entry claims coding and documentation denials and appeals accounts receivable follow-up payment posting adjustments write-offs credits refunds and account notes
• Identify billing errors missed charges duplicate billing preventable denials incorrect adjustments underpayments revenue leakage and other quality concerns and the patterns and recurring issues behind them
• Conduct root-cause analysis to determine whether errors result from employee performance training processes systems payer requirements or inadequate controls
• Quantify the financial impact of audit findings where appropriate
• Maintain accurate supporting documentation for audit findings track corrective actions and conduct follow-up audits to confirm issues stay resolved
• Escalate significant recurring or potential compliance concerns to the Director of Compliance promptly
• Develop and maintain quality assurance reporting covering audit results error rates recurring findings trends financial impact and corrective actions
• Communicate findings clearly and objectively distinguishing individual performance issues from training gaps process deficiencies system issues and compliance concerns
• Help build and standardize Emergicons revenue cycle quality assurance program including audit tools scorecards sampling methods and written procedures
• Review current workflows and collaborate with revenue cycle leadership and subject-matter experts to develop or improve standard operating procedures (SOPs)
• Maintain confidentiality and objectivity throughout the audit process and safeguard protected health information and company financial information
• Align with and adhere to Emergicons core values
• Perform other job-related duties as assigned

EDUCATION ANDEXPERIENCE

• Associates degree in healthcare administration business or a related field required or equivalent practical revenue cycle experience
• Minimum of three (3) years of healthcare revenue cycle medical billing coding accounts receivable denial management auditing quality assurance or compliance experience required
• Demonstrated working knowledge of end-to-end healthcare revenue cycle operations required
• Experience working in healthcare billing or revenue cycle systems required
• Direct experience in revenue cycle quality assurance or auditing preferred
• EMS or ambulance billing (or other emergency-services healthcare billing) experience preferred
• Experience across Medicare Medicaid commercial managed care and self-pay accounts preferred
• CPMA CPC CRCR CHC CAC or comparable healthcare auditing coding or compliance certification preferred

KNOWLEDGESKILLS AND ABILITIES

• Strong analytical and investigative skills including sampling trend identification root-cause analysis and quantifying financial impact
• Proficiency in Microsoft Excel including large data sets lookups and pivot tables
• Ability to learn and audit within Emergicons billing platform and related payer and clearinghouse systems
• Ability to design practical audit tools scorecards and error classifications that employees and leadership can understand and use
• Comfort adopting automation and AI-assisted tools that streamline audit and reporting work
• Alert to billing documentation payer and compliance risks and quick to recognize emerging trends
• Curious asks why errors happen and investigates root causes rather than stopping at the error
• Responsive acts promptly on significant findings and communicates clearly with the right stakeholders
• Objective and consistent applying documented audit criteria while staying independent from the teams being audited
• Strong discretion with protected health information and confidential company information

WORKINGCONDITIONS

This position involves extended periods of sitting orstanding at a desk while working on a computer. Work is hybrid splitting timebetween Emergicons Terrell TX office and a remote environment that supportsthe safe handling of confidential financial and protected health information.

BENEFITS:

Emergicon invests in its people with a full benefitspackage: health insurance dental vision life insurance 401(k) retirementplan and short-term disability and critical illness coverage.

Offer of position is contingent on passing a pre-employmentbackground check and drug screening.

With a close-knitOne Team. One Sound. culture Emergicon offers real room to growfor people who want to make an impact in the EMS industry.

Emergicon LLC is anEEO Employer - M/F/Disability/Protected Veteran Status