- Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.
Job Summary
- The Charge Entry Quality Assurance (QA) Specialist is responsible for ensuring accuracy and compliance in the charge entry process within the revenue cycle management department. This role involves reviewing, validating, and auditing charge entries to maintain high standards of data integrity, billing accuracy, and regulatory compliance. The QA Specialist collaborates closely with billing staff, coding professionals, and other stakeholders to identify and address discrepancies, errors, and process inefficiencies. Additionally, the QA Specialist may contribute to training initiatives and process improvement projects aimed at enhancing charge entry practices.
Essential Functions And Tasks
Quality Assurance:
- Conduct routine audits of charge entry transactions to ensure accuracy, completeness, and adherence to billing guidelines and regulatory requirements.
- Identify discrepancies, errors, and anomalies in charge entry data and escalate issues to relevant stakeholders for resolution.
- Review charge entry documentation for proper coding, documentation, and authorization, verifying that all required information is captured accurately.
- Maintain meticulous records of audit findings, corrective actions, and trends to facilitate continuous improvement.
Compliance Monitoring:
- Stay updated on relevant healthcare regulations, coding guidelines, payer policies, and industry best practices related to charge entry.
- Perform periodic reviews to ensure compliance with billing regulations, including but not limited to HIPAA, Medicare, and Medicaid guidelines.
- Collaborate with compliance officers and regulatory specialists to address compliance concerns and implement corrective measures as needed.
Training and Education:
- Develop and deliver training materials and resources to educate charge entry personnel on coding updates, billing policies, and procedural changes.
- Provide guidance and support to billing staff regarding charge entry best practices, coding conventions, and documentation requirements.
- Offer feedback and coaching to enhance the skills and competencies of charge entry team members, promoting a culture of continuous learning and improvement.
Process Improvement:
- Identify opportunities to streamline charge entry workflows, optimize revenue cycle processes, and enhance operational efficiency.
- Collaborate with cross-functional teams to implement process improvements, automation tools, and quality control measures.
- Analyze key performance indicators (KPIs) and performance metrics to assess the effectiveness of charge entry operations and recommend corrective actions as needed.
Education And Experience Requirements
- Bachelor's degree in any related field (or equivalent work experience).
- Minimum of 2-3 years of experience in revenue cycle management, medical billing, or healthcare finance.
Knowledge, Skills, And Abilities
- Proficiency in medical terminology, CPT, HCPCS, and ICD-10 coding conventions.
- Strong analytical skills with the ability to identify patterns, trends, and anomalies in data.
- Excellent attention to detail and accuracy in reviewing complex billing and coding information.
- Knowledge of healthcare regulations, compliance requirements, and payer policies.
- Effective communication skills with the ability to collaborate across multidisciplinary teams.
- Experience with electronic health record (EHR) systems, billing software, and revenue cycle management tools.
- Commitment to maintaining confidentiality and integrity in handling sensitive patient information.
- Ability to prioritize tasks, manage time efficiently, and meet deadlines in a fast-paced environment.
Ventra Health
Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.
Recruitment Agencies
Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.
Solicitation of Payment
Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.
Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [Confidential Information] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.
