Job Summary:

Under direct supervision, the Quality Auditor is responsible for completing routine medical records office work such as scanning, organizing, and filing medical documents. Communicates with government agencies, regional offices, and QTC personnel to obtain and/or send medical records data. Performs documentation and review of medical service procedures to ensure compliance and accuracy with company billing policies and procedures, contractual requirements, and governmental billing regulations.

Essential Duties and Responsibilities:

• Review the case management system to identify outstanding reports and diagnostic results
• Communicate with medical offices and diagnostic facilities to obtain reports
• Upload diagnostic results received to the case management system
• Process faxes received
• Analyze and validate medical records documentation to ensure the services ordered equal the services performed and billed
• Perform moderate to complex audits to assist in trend identification
• Utilize data analysis and extraction tools to evaluate billing transactions and identify potential billing errors
• Identify and research audit findings, presenting concerns and solutions to appropriate leadership
• Ensure all information related to findings are appropriately documented according to company policies and procedures
• Process feedback received via phone or email, notate appropriately and forward to correct department per workflow.
• ,Complete most routine audit functions with minimal supervision
• Interface with operational departments to ensure customer requirements are met
• Meet individual productivity and quality goals.
• Perform other duties and responsibilities as assigned

Competencies:

• Proficient computer skills including Microsoft Office Suite, with advanced knowledge in Excel
• Ability to manage multiple tasks simultaneously, work independently with minimal supervision and meet stringent deadlines
• Attention to detail/excellent follow-up skills
• Proactive, self-motivated, and quality-results oriented
• Strong organizational, problem-solving, and communication skills
• Knowledge of medical billing practices
• Ability to investigate, fact find and provide evidence towards case resolution
• Excellent verbal and written communication skills
• Excellent interpersonal skills with the ability to work with individuals at all levels of the organization

Education and/or Experience: (includes certificate & licenses)

• High School diploma, or equivalent (GED)
• 3 to 5 years of experience
• Medical terminology in a medical billing environment is preferred
• Must be able to successfully pass contractually required Federal background check
• Contract requires U.S. citizenship and the ability to obtain a DoD Common Access Card (CAC)
• Knowledge of military medical examinations preferred

This job description supersedes all prior job descriptions and is intended to describe the general content and essential requirements for the position listed above. It is not to be construed as an exhaustive statement of requirements, duties, and responsibilities. Management reserves the right to add or change the duties of this position as required at any time.

QTC Management Inc. is a VEVRAA Federal contractor and an Equal Opportunity Employer. The company has an ongoing commitment to affirmative action and the creation of a workplace free of discrimination, harassment and retaliation. The company recruits, hires, trains, and promotes individuals in all job titles without regard to race, color, creed, religion, ancestry, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, people with disabilities protected under law, and protected veteran status.

Experience

• 3 - 5 years: Relative Experience

• Knowledge of military medical examinations preferred
• Medical terminology in a medical billing environment preferred

Education

• High School Diploma or better

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)