Supervisor, Pre-claim QA

2 months ago

Perungudi Chennai Tamil Nadu, India Ventra Health, Inc. Full time

About Us:

- Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Job Summary:

- As a Supervisor, Pre-Claim Quality Assurance, your role involves overseeing a team responsible for maintaining the accuracy and efficiency of demo (demographic) data entry and charge entry processes within a healthcare organization's revenue cycle management.

Essential Functions and Tasks:

- **Supervision and Leadership**: Provide leadership, guidance, and support to a team of quality assurance specialists responsible for demo and charge entry processes.
- ** Quality Assurance Management**: Develop, implement, and maintain quality assurance processes and procedures to ensure accurate and timely entry of demographic information and charges into the healthcare organization's systems, including electronic health records (EHR) and billing software.
- ** Training and Development**: Train, mentor, and coach team members to ensure they possess the necessary skills and knowledge to perform demo and charge entry duties accurately and efficiently.
- ** Performance Monitoring and Evaluation**: Monitor team performance metrics, conduct regular performance evaluations, and provide feedback to drive continuous improvement and meet productivity targets.
- ** Issue Resolution and Escalation**: Address and resolve any discrepancies, errors, or issues related to demo and charge entry promptly and effectively. Escalate complex issues to appropriate stakeholders for resolution as needed.
- ** Collaboration and Communication**: Collaborate with other departments such as billing, coding, clinical operations, and finance to streamline processes, resolve issues, and improve overall revenue cycle management efficiency. Communicate effectively with team members, management, and stakeholders to ensure alignment with organizational goals and objectives.
- ** Compliance and Regulatory Adherence**: Ensure compliance with relevant healthcare regulations, billing guidelines, payer policies, and industry standards governing demo and charge entry activities.
- ** Documentation and Reporting**: Maintain accurate records, documentation, and audit trails of demo and charge entry activities. Generate reports, analyze data, and identify trends to support decision-making and process improvement initiatives.

Education and Experience Requirements:

- Bachelor's degree in any related field.
- A minimum of 6 years of experience in healthcare revenue cycle management, with a focus on specifically in demo entry, charge entry, or related areas, is typically required. Supervisory or leadership experience is preferred.
- Strong leadership, management, and team-building skills with the ability to motivate, empower, and develop team members.

Knowledge, Skills, and Abilities:

- Exceptional attention to detail and accuracy to identify and rectify discrepancies in demo and charge entry records.
- Proficiency in data analysis, problem-solving, and critical thinking to identify root causes of issues and implement effective solutions.
- Excellent verbal and written communication skills to effectively communicate with team members, management, stakeholders, and external parties.
- Understanding of healthcare regulations such as HIPAA, Medicare, Medicaid, and third-party payer policies related to demo and charge entry.
- Ability to adapt to changing priorities, handle pressure, and work effectively in a fast-paced environment with tight deadlines.

Ventra Health:
**Equal Employment Opportunity (Applicable only in the US)**

**Recruitment Agencies**

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

**Solicitation of Payment**

Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.

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