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
As a Pre-Bill Quality Assurance (QA) Specialist, you will play a crucial role in ensuring the accuracy and integrity of patient demographic data and charge entry within the healthcare system. Your responsibilities will include meticulous data entry, thorough quality assurance checks, and adherence to regulatory standards to support the efficiency and reliability of healthcare billing processes.
Essential Functions And Tasks
Data Entry:
Accurately input patient demographic information into the healthcare database system.
Enter charges for medical services rendered by healthcare providers according to established procedures and coding standards.
Ensure timely completion of data entry tasks to support billing processes and reimbursement.
Quality Assurance:
Conduct thorough quality checks on demographic data and charge entry to identify discrepancies, errors, or inconsistencies.
Verify the accuracy of patient information, including insurance details, contact information, and medical history.
Review charge entries for completeness, accuracy, and compliance with coding guidelines and billing regulations.
Documentation and Reporting:
Maintain detailed documentation of data entry and quality assurance activities.
Generate reports on data entry accuracy, charge entry errors, and quality assurance findings.
Communicate findings to relevant stakeholders, including billing managers, healthcare providers, and administrative staff.
Compliance and Regulation:
Stay updated on healthcare regulations, coding standards, and billing requirements.
Ensure compliance with HIPAA regulations and other data protection laws in handling patient information.
Implement best practices for data entry and charge entry to minimize errors and mitigate compliance risks.
Collaboration and Communication:
Collaborate with other healthcare administrative staff to resolve data discrepancies and address billing issues.
Communicate effectively with billing teams, coding specialists, and healthcare providers to ensure accurate and timely billing processes.
Provide support and guidance to colleagues on data entry procedures and quality assurance standards.
Education And Experience Requirements
Bachelor's degree in any related field.
Proven experience of minimum 4 years in providing support in healthcare data entry, medical billing.
Knowledge, Skills, And Abilities
Proficiency in using healthcare database systems and billing software.
Knowledge of medical terminology, CPT codes, and ICD-10 coding standards.
Attention to detail and strong analytical skills to identify errors and discrepancies.
Excellent organizational and time management abilities to meet deadlines and manage multiple tasks.
Strong communication skills, both written and verbal, for effective collaboration and reporting.
Familiarity with HIPAA regulations and healthcare compliance standards.
Certification in medical billing and coding (e.g., CPC, CCS) is a plus.
