Sr. RCM Quality Assurance Specialist

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:

The Senior RCM Quality Assurance Specialist is responsible for performing quality assurance audits to ensure clean and timely filing of claims, as well as preparing reports and trends.  Duties include preparing weekly, monthly reports, auditing data within the practice management system and making edit recommendations.  Position will work closely with RCM Leadership on projects as they arise.

Responsibilities:

• Ensure quality and payer requirements are met.

• Prepare and update job aids for payer specific requirements.

• Review and research rejection, denials trends, provide analysis.

• Propose and implement ACE edits for approval.

• Monitor denials and work with RCM Managers to identify and address root causes.

• Review adjustments and interact with leadership team as training opportunities are identified.

• Identify and incorporate audits to monitor performance in key areas of RCM.  Working closely with leadership to troubleshoot as required.

• Monitor, identify and report trends based on data reviews.

• Work on special projects as assigned.

• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications:

• Bachelor’s Degree or equivalent experience.

• Minimum 5 years of experience in oncology or healthcare billing. 

• Experience with working with BPO teams

• Proficiency with computer systems and Microsoft Office software programs.

• Robust understanding of capitated and shared risk payer profiles.

• Strong background in Unlimited Systems, Centricity.

• Understanding of research billing, invoiceable.

• Strong knowledge of Microsoft Office software applications (e.g., Excel, Outlook and Word).

• Ability to meet deadlines.

Essential Competencies:

• Excellent verbal and written communication skills.

• Ability to prioritize work and manage time efficiently.

• Self-motivated, able to work autonomously, multi-task and switch focus quickly.

• Ability to apply good judgment.

• Strong organizational skills and attention to detail.

• Attendance is an essential job function.

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