RCM QA Specialist

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• South Florida Business Journal, Best Places to Work 2024
• Inc. 5000 Fastest-Growing Private Companies in America 2024
• 2024 Black Book Awards, ranked #1 EHR in 11 Specialties
• 2024 Spring Digital Health Awards, "Web-based Digital Health" category for EMA Health Records (Gold)
• 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)

Who we are:

We Are Modernizing Medicine (WAMM) We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.

The RCM Quality Assurance (QA) Specialist will be responsible for auditing the work of RCM analysts to ensure the highest standards of services are delivered. They will play a pivotal role in identifying process gaps and work closely with onshore and offshore teams to define SOPs and decision trees that will improve the process. 

The Role:

• Apply quality assurance expertise by closely monitoring trends, identifying transactions and processes for audits, presenting audit outcomes and recommendations to mitigate gaps to the operations team for resolution.  
• Utilize tools and technologies available to ensure quality concerns are proactively identified and corrected.   
• Work closely with operational teams to resolve process ambiguity by calibrating on audit process and parameters.
• Ensure Standard Operating Procedures (SOPs) and client specific practice instructions are followed and report any gaps identified with recommendations for improvement. 
• Continuously improve the quality processes by suggesting innovative ways quality concerns can be quickly identified, fixed and monitored to avoid recurrence.  
• Actively monitor for compliance as per HIPAA guidelines and report any incidence of non-compliance.  
• Actively participate in quality and training huddles, create content, and deliver necessary training to resolve identified skill or knowledge gaps on the team.
• Audit for adherence to SOPs and other guidelines and provide references and feedback.  
• Review customer feedback/concerns and ensure that corrective action is being taken, adhering to the plan of action.
• Provide feedback on SOPs so that the processes and procedures are created in such a way that these can be implemented most effectively.
• Propose changes in decision trees through which inefficiencies and redundancies can be eliminated.
• Participate and contribute to the success of new clients by identifying any bottlenecks during implementations.
• Provide training and guidance to team members to improve their knowledge and skills so they are sufficiently equipped to deliver best in class services.
• Collaborate with the onshore quality team to ensure consistency on processes and procedures being followed across Modmed locations. 
• Perform additional projects and job duties as assigned.

Skills & Requirements:

• Bachelor's Degree -Bachelor's preferably  in Human Science / Commerce/ Business Administration preferred 
• Certification in Quality Improvement and Assurance
• 5+ years of relevant working experience in core Provider RCM out of which minimum 2 years as SME, QA, QA Lead, etc. within a professional setting.
• Hands-on knowledge of the key functions within RCM is a must.
• Prior experience of working on Modmed products is a plus. 
• Experience working on process improvements/ six sigma quality projects preferred. 
• Proven knowledge of various insurance carriers, including Medicare, private HMOs, PPOs, Capitation and Workers' Comp. etc.
• Advanced excel skills such as the ability to use formulas to analyze data, create and format pivot tables and templates, use and conditional formatting and validation functions, able to create visualizations of data through charts, graphs and powerpoint; able to manage information located in multiple software systems.
• Exceptional written, verbal, and interpersonal communication skills required.
• Committed to developing expertise in respective ModMed products (PM or gPM) within 3 months of employment.
• Professional demeanor, team player, strong time management skills required.
• Able to work during US night shifts within a hybrid work model from home and office is required - this position requires working closely with onshore/offshore teams, as well as with payer reps.

ModMed Benefits Highlight:  At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:

India

• Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
• Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
• Allowances: Annual wellness allowance to support your well-being and productivity,
• Earned, casual, and sick leaves to maintain a healthy work-life balance,
• Bereavement leave for difficult times and extended medical leave options,
• Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
• Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.

United States

• Comprehensive medical, dental, and vision benefits, including a company Health Savings Account contribution,
• 401(k):  ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
• Generous Paid Time Off and Paid Parental Leave programs,
• Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,
• Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,
• Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,
• Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,
• Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.

PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address ). Please check senders' email addresses carefully.  Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.