Quality Assurance Collections Specialist

Job 158124 - Quality Assurance Collections Specialist
Miami, FL

The Quality Assurance Collections Specialist is responsible for auditing Collectors and ensuring they are working denials and no responses accurately. This position is responsible for developing, recommending and monitoring corrective and preventive actions within the collections department.

The primary objective of the Quality Assurance Collections Specialist is to ensure the services of the collections department meet the established standards for quality including accuracy, efficiency, and competency.

• Achieve or exceeddepartment goals as defined by the department director
• Implements initiatives and strategies to reduce errors
• Draft quality assurance policies and procedures
• Interpret and implement quality assurance standards
• Evaluate adequacy of quality assurance standards
• Devise sampling procedures and directions for recording and reporting quality data
• Review the implementation and efficiency of quality systems
• Document internal audits and other quality assurance activities
• Investigate customer complaints and non-conformance issues
• Collect and compile statistical quality data
• Analyze data to identify areas for improvement in the quality system
• Develop, recommend and monitor corrective and preventive actions
• Prepare reports to communicate outcomes of quality activities
• Identify training needs and organize training interventions to meet quality standards
• Evaluate audit findings and implement appropriate corrective actions
• Assure ongoing compliance with quality and industry regulatory requirements

• Excellent working knowledge of insurance carriers' payment regulations including various reimbursement schemes, coinsurance and deductibles, and contractual adjustments
• Knowledge of Medicare, managed care and commercial insurances
• Working knowledge of HIPAA regulations and compliance
• Knowledge of modifiers and their proper use required
• Works with payers to determine reasons for denials, corrects and reprocesses claims for payment in a timely manner
• Maintains relationships with insurance companies
• High attention to detail and the ability to multi-task
• Possess a working knowledge of Microsoft Outlook, Word, and Excel
• Strong verbal and written communication skills
• Data collection, management, and analysis
• Problem analysis and problem solving
• Ability to plan and organize
• Ability to make decisions
• Ability to work with multiple teams

• Combination of education and industry experience may be considered in lieu of BS/BA

Certifications in Quality Auditor, Quality Engineer, Quality Improvement Associate, and/or Six Sigma a plus

• Quality inspection, auditing, and testing experience a plus
• Knowledge of tools, concepts and methodologies ofQA
• Knowledge of relevant regulatory requirements
• Experience with implementation of corrective action programs