Quality Assurance & Audit Manager
This position is responsible for the management of a range of auditing and monitoring duties, including the analysis and review of operational controls and business processes for adherence with State and Federal requirements and PrimeWest Health policies, procedures, and standards. The Quality Assurance & Audit Manager oversees analyses of a wide variety of data, and develops conclusions and recommendations. This position applies analytical, conceptual, and logic skills to business concepts and develops them into operational methods. In addition, the Quality Assurance & Audit Manager is responsible for the review of regulatory and system notifications from the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS) pertaining to the review of encounter data processing exceptions.
Educational Requirements and Required Qualifications
At minimum, four years of post-high school education in business or a field of study related to health care compliance and/or claims administration; may substitute experience in health care billing or claims payment administration on a year-for-year basis. At least 3 years in a management/leadership role or demonstrated progressive growth. Four or more years of health care claims or claims-related experience in a position with a health care claims payer organization or provider billing environment preferred.
Experience conducting internal/external audits or compliance reviews preferred
Knowledge and understanding of common health care claim code sets, including, but not limited to, CPT, HCPCS, and ICD-10
Ability to independently research and troubleshoot
Demonstrated project management skills
Ability to efficiently navigate the Internet, as well as navigate PrimeWest Health applications and systems
Demonstrated knowledge of, and proficiency in, Word, Excel (including developing and using formulas, pivot tables, VLOOKUP functions, charts, etc.), and Outlook required. Use of other applications as needed.
Effective conflict resolution, problem-solving, analytical, and negotiating skills
Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills.
Willingness to work hours necessary to successfully accomplish assigned tasks in a timely manner
Willingness to learn new skills as may be required by the position
Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 25 pounds. Infrequent travel may be required.