Quality Assurance Specialist I job at Viva Health in Birmingham, AL
Title: Quality Assurance Specialist I
Location: Birmingham, AL
Job Description:
Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities. Must be available to work during the core hours of operation, 8am to 5pm Monday through Friday, and overtime as required.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
Tuition Assistance
Flexible Spending Accounts
Healthcare Reimbursement Account
Paid Parental Leave
Community Service Time Off
Life Insurance and Disability Coverage
Employee Wellness Program
Training and Development Programs to develop new skills and reach career goals
Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Quality Assurance (QA) Specialist is responsible for the overall development and implementation of quality assurance in an effort to provide customers with superior service. This role is responsible for auditing and reporting analysis of Claims and Entry staff, Commercial Customer Service phone queue calls, Medicare Member Services phone queue calls, System Configuration, and Provider/Fee Configuration.
Key Responsibilities
Review Claims Entry and Adjudication staff for accuracy based on applicable plan coverage documentation in accordance with departmental policies and procedures, company compliance plans, and all regulatory guidelines.
Document and distribute error findings to management for review. Provide training and education to Claims Entry and Adjudication staff on claims payment issues to ensure claims are adjudicated in an effective and efficient manner.
Identify and report benefit configuration issues; communicate with internal departments to resolve problems that affect claim payment.
Investigate claim submissions for coding inaccuracies, review high dollar remittances for payment and benefit configuration accuracy. Report overall Company cost-savings to management.
Conduct phone audits of randomly selected and/or focused Medicare Member Services or Commercial Customer Service inbound phone calls. Produce scorecard for each call audited.
REQUIRED:
High School Diploma or GED
2 years' experience with all components of claims processing, Medicare enrollment, and/or customer service
Knowledge of ICD9, CPT, HCPCS, HCFA, Uniform Billing codes, and Co-ordination of Benefits (COB)
Proficient in medical terminology
Demonstrate excellent customer service skills through written and verbal communication
Ability to prioritize and multitask while maintaining organization and attention to detail
Ability to work in a team environment, remaining flexible to ideas, routines and schedules, recognizing responsibilities, and actively participating with others to accomplish assignments and achieve desired goals
PREFERRED:
PowerSTEPP (TXEN) experience
Quality Assurance experience
Coding experience
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Location: Birmingham, AL
Job Description:
Work Schedule: Hybrid schedule with regular onsite presence at the VIVA HEALTH corporate office and some work-from-home opportunities. Must be available to work during the core hours of operation, 8am to 5pm Monday through Friday, and overtime as required.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
Tuition Assistance
Flexible Spending Accounts
Healthcare Reimbursement Account
Paid Parental Leave
Community Service Time Off
Life Insurance and Disability Coverage
Employee Wellness Program
Training and Development Programs to develop new skills and reach career goals
Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Quality Assurance (QA) Specialist is responsible for the overall development and implementation of quality assurance in an effort to provide customers with superior service. This role is responsible for auditing and reporting analysis of Claims and Entry staff, Commercial Customer Service phone queue calls, Medicare Member Services phone queue calls, System Configuration, and Provider/Fee Configuration.
Key Responsibilities
Review Claims Entry and Adjudication staff for accuracy based on applicable plan coverage documentation in accordance with departmental policies and procedures, company compliance plans, and all regulatory guidelines.
Document and distribute error findings to management for review. Provide training and education to Claims Entry and Adjudication staff on claims payment issues to ensure claims are adjudicated in an effective and efficient manner.
Identify and report benefit configuration issues; communicate with internal departments to resolve problems that affect claim payment.
Investigate claim submissions for coding inaccuracies, review high dollar remittances for payment and benefit configuration accuracy. Report overall Company cost-savings to management.
Conduct phone audits of randomly selected and/or focused Medicare Member Services or Commercial Customer Service inbound phone calls. Produce scorecard for each call audited.
REQUIRED:
High School Diploma or GED
2 years' experience with all components of claims processing, Medicare enrollment, and/or customer service
Knowledge of ICD9, CPT, HCPCS, HCFA, Uniform Billing codes, and Co-ordination of Benefits (COB)
Proficient in medical terminology
Demonstrate excellent customer service skills through written and verbal communication
Ability to prioritize and multitask while maintaining organization and attention to detail
Ability to work in a team environment, remaining flexible to ideas, routines and schedules, recognizing responsibilities, and actively participating with others to accomplish assignments and achieve desired goals
PREFERRED:
PowerSTEPP (TXEN) experience
Quality Assurance experience
Coding experience
Apply tot his job
Apply To this Job