Revenue Cycle Quality Specialist

Help us change lives

At Exact Sciences, we’re helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you’re working to help others.

Position Overview

The Revenue Cycle Quality Specialist supports Exact Sciences and all order to cash processes within the Revenue Cycle areas to ensure that teams are providing the highest quality results. This position reviews and provides direct assessment of people, workflow processes and system build to ensure that required quality standards are met in accordance with available documentation and work instruction. They collaborate with members of the Revenue Cycle leadership, Corporate Training and System Support Services teams as necessary, to support the design, development and implementation of documentation materials based on key trends identified in the quality review process.

Essential Duties

including but not limited to the following:

• Perform audit reviews (including sample selection) for each of the functions of the Revenue Cycle and associated contractors, which include, but are not limited to, order entry and notation, non-order document processing, order exception handling processes, faxing and results delivery, coverage, eligibility, system queue resolution cash and other revenue cycle tasks.
• Review, interpret and assess system obtained quality samples and reporting.
• Learn, master and maintain competency in multiple order to cash work processes.
• Use Microsoft Office applications and other tools to compile and track performance.
• Provide feedback and assign errors, utilizing description/error codes with additional commentary.
• Identify examples and participate in calibration exercises.
• Adhere to audit assignments and time frames for completion.
• Lean Six-sigma White belt certification is required within the first six months in this position.
• Perform additional duties as assigned.
• Maintain or exceed both quality and productivity goals, as defined by the department.
• Ensure compliance with all Company quality procedures and guidelines; including, but not limited to, Quality Policy and Code of Business Conduct and Ethics.
• Proficient in researching missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors. 
• Proficient in analyzing, researching claim issues applying federal, state, payor rules and procedures.
• Ability to work in a team environment and adapt to changing workloads and new information.
• Stay current with relevant guidelines and policies for the Revenue Cycle teams, contractors and medical devices (e.g., HIPAA, Medical Device Reporting, etc.).
• Maintain strictest confidentiality; and adhere to all HIPAA guidelines/regulations. 
• Uphold company mission and values of accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System, Revenue Cycle policies, Standard Operating Procedures and other related documentation.
• Regular and reliable attendance.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90 % of a typical working day.

Minimum Qualifications

• Associates degree in Business, Analytics, Healthcare, or related field; or High School Degree/General Education Diploma and 2 years of relevant experience in lieu of Associates degree.
• 1+ year of experience in data entry, revenue cycle, quality audits, or in a laboratory setting.
• 2+ years of experience in professional medical billing, claims, and insurance processing. 
• Working knowledge of government, managed care, and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes.
• Strong knowledge of EHR operating systems involving investigation and correction of accounts; including updates to patient demographics, financial, and guarantor information. 
• Proficiency in Microsoft Office applications.
• Proficient computer skills to include Internet navigation, Email usage, and word processing. 
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation. 
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• 3+ years of experience in medical or insurance billing field.
• 2+ years of experience in data entry, revenue cycle, quality audits.
• Experience wit