ROLE SUMMARY
The DQA Representative is responsible for ensuring that information and documentation required for proper billing of claims is obtained and presented for all billable events for an assigned area.
This is a Non-Exempt/Hourly position.
KEY RESPONSIBILITIES
Specific Duties:
Demonstrates knowledge, understanding and compliance of company policies and procedures.
Demonstrates knowledge and understanding of (and compliance with) Federal, State, and local laws, rules, regulations, and guidelines as they pertain to reimbursement, collections, and compliance.
Demonstrates complete knowledge of proper billing, coding, and posting procedures.
Ensure security of buildings and all other company property.
Performs daily appropriate housekeeping duties.
Ability to work as a team member.
Complete and maintain appropriate training, certification, and licensure for their position.
Maintain a high level of customer service when dealing with patients, patient families, co-workers clients, other healthcare providers, and the general public.
Notify DQA Manager of any lapses in documentation resulting in less than full compliance with compliance and HIPAA standards.
Maintains security and privacy of all company and patient information at all times in accordance HIPPA and all other local, state, and federal regulations.
Is responsible for keeping billing and patient care records secure in accordance with proper HIPAA and document retention standards.
Reports to assigned shifts on time and properly groomed in appropriate business attire.
At all times sets an example of professionalism and places customer service, compliance, and safety above all else.
Notifies DQA Manager of any questions, concerns, or issues regarding billing, collections, or compliance matters.
Work closely with Operations and Dispatch Management and Personnel to ensure timely, accurate, and complete information and documentation is available to be submitted for proper billing services.
Thoroughly evaluate all documentation received from Operations Personnel (example PCRs, PCSs), Dispatch Personnel (example: CAD records, call types, priorities), and external customers (example: insurance and demographic information) and ensure any shortcomings or discrepancies are addressed prior to submitting documentation and information to the billing office. Should ensure that all items listed on the DQA Key Data Point Review Sheet are reviewed, present, and accurate prior to submission.
Timely process assigned work and appropriately forward information and documentation to the billing office using the assigned workflow options.
Perform other duties related to DQA or as assigned by management.
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PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.
The ability to reach, push and pull.
Ability to sit, stand, walk, bend, and lift up to 20 pounds occasionally
Ability to use computers and office equipment for extended periods
Ability to review detailed reports and documentation for prolonged periods
Occasional travel to operational locations may be required
CORE COMPETENCIES
Attention to Detail
Documentation Review
Compliance Awareness
Communication Skills
Time Management
Critical Thinking
Team Collaboration
Accountability
Organizational Skills
Confidentiality
REPORTING RELATIONSHIP
Reports directly to the DQA Manager or designee.
WORK ENVIRONMENT & TRAVEL
Travel Requirements
Occasional local travel may be required.
Work Environment
This position works in an office and operational support environment reviewing clinical and operational documentation. Limited exposure to field operations and healthcare settings may occur.
