51 applicants

Company

OneOncology · 3 days ago

RCM Coding Quality Assurance Manager

United States

Full-time

Remote

Mid, Senior Level

5+ years exp

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Responsibilities

Lead the development of the quality review and audit plan, aligning priorities with organizational risk management, regulatory requirements and following internal policy and procedures.

Oversee the strategic direction of the quality review program, including timelines, methodologies, and reporting standards.

Provide insight and advice to OneOncology Leadership on quality review audits and trends.

Oversee coder/biller pre-bill and performance improvement pre-bill reviews to ensure compliance standards are met with an accuracy rate of 95% or better.

Oversee and mentor RCM Coding QA Auditors and/or outsourced QA vendor, fostering a culture of continuous improvement and excellence.

Develop and deliver training materials to end users to improve performance and success rates.

Manage and oversee internal and external personnel audits ensuring adherence to state, federal, and contractual requirements through quality reviews of claims and medical record evaluations.

Direct the end-to-end management of quality audit projects from planning to completion, including oversight of sample selection, documentation review, and corrective action follow-up.

Oversee the development and presentation of dashboards and quality review reports for OneOncology leadership and partner practices, including physicians.

Lead special project initiatives for quality reviews, providing high-level support and follow-up, and ensuring successful execution under the strategic direction of the Director of RCM Coding and VP, RCM Delivery.

Proactively monitor data quality and integrity to identify opportunities for quality improvement.

Research, effectively apply and train employees on current billing and coding regulations, auditing, and professional standards.

Other duties assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualification

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CPC certificationAuditing experienceLeadership experienceCPMA certificationData-driven decision makingMicrosoft Office proficiency

Required

CPC or other coding certification required

Bachelor’s Degree or equivalent experience required

5+ years of auditing and leadership combined experience required

Strong communication and interpersonal skills

Proficiency with Microsoft Office products

Ability to meet deadlines

Demonstrated success in using data to make decisions and drive behavior change to support organizations

Preferred

CPMA certification preferred

Company

OneOncology

OneOncology is a partnership of oncologists and industry leading experts driving the future of community-based cancer care in the US. It is a sub-organization of General Atlantic.

Founded in 2018

Nashville, Tennessee, USA

1,001-5,000 employees