- 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 healthcare Intake QA Specialist is responsible for ensuring the accuracy and compliance of healthcare insurance and demographic information within a healthcare organization. This role involves conducting quality assurance audits, identifying discrepancies, and implementing corrective measures to enhance data integrity and regulatory compliance.
Essential Functions And Tasks
Quality Assurance:
- Conduct regular audits of healthcare insurance and demographic data to ensure accuracy and compliance with industry standards and organizational policies.
- Identify discrepancies, errors, or missing information in insurance claims and demographic records.
- Provide detailed feedback to relevant departments and stakeholders based on QA findings.
Claims Review:
- Review and analyze healthcare insurance claims for accuracy and completeness.
- Collaborate with claims processing teams to address discrepancies and ensure timely and accurate claim submissions.
- Verify eligibility, benefits, and pre-authorization requirements for insurance claims.
Demographic Data Verification:
- Verify and validate patient demographic information to ensure accuracy and completeness.
- Collaborate with registration and admission teams to address discrepancies and update records as needed.
- Ensure compliance with patient privacy regulations (HIPAA) during data verification processes.
Documentation and Reporting:
- Maintain accurate and detailed records of QA audits, corrective actions, and outcomes.
- Generate reports on the accuracy and integrity of healthcare insurance and demographic data.
- Communicate QA findings and trends to relevant stakeholders.
Training and Education:
- Develop and deliver training sessions to relevant staff on best practices for collecting, documenting, and verifying healthcare insurance and demographic information.
- Stay informed about changes in insurance regulations and demographic data requirements.
Process Improvement:
- Collaborate with relevant departments to identify and implement process improvements related to insurance claims and demographic data management.
- Propose and implement strategies to enhance accuracy, efficiency, and compliance.
Education And Experience Requirements
- Bachelor's degree in any related field.
- Minimum of 4 years of experience in healthcare insurance and demographic data management.
Knowledge, Skills, And Abilities
- Knowledge of insurance billing and coding practices.
- Familiarity with healthcare regulations, including HIPAA.
- Strong analytical skills and attention to detail.
- Excellent communication and interpersonal skills.
- Proficient in using healthcare information systems and software.
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/.
