What are the responsibilities and job description for the RCM Quality Assurance Specialist position at OneOncology?
OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology's mission and vision.
Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.
Job Description :
Quality Assurance Specialist works under the direct supervision of the Director of Revenue Management and acts as a liaison between the imaging centers.
Responsibilities :
- Obtain, compile, and maintain fee schedules for all active imaging CPT / HCPCS.
- Responsible for quarterly audit of fee schedule comparison against payer remits / EOBs to identify fee schedule variance and communicate any notable changes to management.
- Reviews and approves hardship applications received from the imaging facilities per established guidelines.
- Review and approve collection adjustments (write-offs, payment settlements, probate, etc.) per established guidelines and within designated range.
- Reviews and approves refund requests with appropriate director oversight and sends to AP department for processing monthly.
- Follow up on payer trends, medical necessity denials, and issues as directed by supervisor. Compile and present findings at scheduled imaging center meetings.
- Organizes meetings and prepares agenda to discuss issues and collaborate with imaging centers personnel.
- Serve as point of contact for imaging patient medical records requests. Compile, review and submit the requested medical records to the appropriate imaging collector within 48 hours of the request.
- Audit imaging clinical trial patients monthly and prepare spreadsheet for SCRI invoicing. Follow-up to ensure appropriate payment is received.
- Acts as point of contact for imaging centers to answer questions and facilitate information as needed.
Required Qualifications :
Essential Competencies :
LI-LK1
LI-REMOTE
