Medical Billing Quality Assurance Specialist - Full-time / Part-time

Duties include:

Manage the open and hold numbers
Ensure accurate paperwork
Familiar with insurance requirements
Working reports which include: prior authorization, open and hold, billers reports, expiring reports Following the Standardized Process
Understanding AXXESS on the billing side
Understanding the full-cycle of billing from intake to receipt of payment
Work with the Billing Team to resolve billing and claim issues
Review all Medicare and other episodic payers' clinical records at the local level to assure appropriate documentation for reimbursement.
This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with
physicians, adherence to the care plan, and evidence of communication between disciplines.
Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure,
certification, and accreditation results.
Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
Identify clinical problem areas and document deficiency trends in a proactive approach. Educate administrative and clinical associate staff in the correction of these deficiencies.
Assist with quality improvement and Medicare compliance training program. Utilize Communicate with the Area Education Specialist regarding identified trends of deficiencies with Medicare Conditions of Participation, clinical care, coordination of care, and documentation for the purposes of requiring more extensive education or action of clinical staff.
In accordance with the Branch Director, monitor the receipt of Medicare denials, Billing Compliance held claims, and other payer denial notices.
Assess the validity of these denials, and respond with additional information. Inform the Branch Director and Branch staff of noticeable trends or relevant issues.
In accordance with the Branch Director, prepare and file general appeals on a timely basis. Attend fair hearings as necessary.
Collaborate with the Clinical Leadership and clinical associate staff in resolving complex clinical issues.
Participate in the initial orientation of the clinical associate staff regarding Medicare Conditions of Participation and relevant requirements for care and documentation and provide education during the orientation in the timeliness of paperwork and flow of OASIS.
Collaborate with branch Clinical Leadership to analyze Performance Improvement trends in the delivery of care. Keep up with the performance indicators and monitor the Performance Improvement plan for the branch. Essential in driving performance measures in the branch.
Review OASIS documents for accuracy and completeness prior to locking and submitting data electronically. Explain and mentor clinicians and staff on COP's and on billable skilled visits.
Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of OASIS data, and other related documents, that are being reviewed.
Facilitate the ICD-9/10 coding of the Plan of Treatment based on OASIS data and patient assessment documentation that is assessed at the bedside.
Collaborate with branch leadership to ensure effective and efficient episodic management, utilizing Health Services reports such as Projected vs. Actual, PPS Unbilled and Post Billing Adjustment, to identify trends.
Other Duties as Assigned

About Aerotek:

Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.