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Quality Assurance & Training Lead
Mohawk Valley Health System
People & HR, Quality Assurance
Utica, NY, USA
Posted on Mar 11, 2025
Job Summary
The Quality Assurance and Training Lead for the Patient Financial Services (PFS) Department at MVHS is responsible for overseeing quality assurance initiatives, training, and process optimization to enhance revenue cycle operations. This role ensures accuracy in professional and technical billing processes and develops staff competency through robust training programs.
Serves as a subject matter expert in quality assurance and training. Reporting to the Director of PFS, the Team Lead collaborates with leadership and staff to identify areas for improvement, implement best practices, and maintain compliance with organizational and regulatory standards.
Core Job Responsibilities
Acts as a resource for day to day operations, projects and assignments.
Quality Assurance
- Monitor billing accuracy for professional and technical claims, ensuring compliance with policies and regulations.
- Review error and denial trends to identify improvement opportunities and training needs.
- Develop and implement corrective action plans for recurring issues.
Training Program Development
- Lead the creation, delivery, and maintenance of training programs for PFS staff.
- Lead the development of training materials, including guides, workflows, and competency assessments.
- Coordinate training schedules and ensure new and existing staff are adequately trained.
- Create and promote a positive reinforcement training culture that fosters patience and understanding for various learning speeds and abilities.
Team Leadership
- Ensure alignment of training activities with departmental goals and objectives.
- Act as a resource for complex issues or escalated concerns.
- Act as a role model for staff by demonstrating professionalism, exceptional customer service, and maintaining poise during the most difficult of situations.
Operational Efficiency
- Evaluate and optimize workflows related to billing, payment posting, claim resolution, and self-pay collections.
- Collaborate with PFS leadership to establish and monitor key performance indicators (KPIs) for training and quality assurance.
- Provide recommendations for process improvements to enhance departmental efficiency.
- Responsible for education surrounding any PFS related system upgrades or implementations. Ensure staff is brought up to date on new protocols.
Epic EMR Expertise
- Serve as the department's expert on Epic EMR billing functions, including but not limited to claims, denials, and payment posting workflows.
- Troubleshoot and resolve Epic-related issues.
- Partner with IT to implement Epic updates and ensure staff are trained on system changes.
Compliance and Reporting
- Ensure adherence to federal, state, and payer-specific regulations related to billing and collections.
- Develop reports to track training effectiveness, quality metrics, and departmental performance.
- Present findings and collaborate with PFS leadership on corrective actions.
Perform related duties as directed.
Education/Experience Requirements
REQUIRED:
- High School diploma or equivalent.
- 5 years of experience in health care billing, patient accounting, or patient financial services.
- Demonstrated expertise with EMR systems, specifically in billing and claims resolution.
- Strong analytical and problem-solving skills with proficiency in MS Word and Excel.
- Excellent communication and interpersonal skills.
- Ability to lead, guide and motivate others.
PREFERRED:
- Bachelor’s degree in Business, Healthcare Management, or a related field with 3 years of experience in billing or revenue cycle operations.
- Experience in leading training teams or quality improvement initiatives.
Licensure/Certification Requirements
REQUIRED:
- EPIC Credentialed Trainer or obtained within 6 months of hire.
PREFERRED:
- Certification in healthcare billing or revenue cycle management (e.g., CRCR, CPAT).
Disclaimer
Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.
Job Details
Req Id 93935
Department ACCTS RECEIVABLE & COLLECTION
Shift Days
Shift Hours Worked 8.00
FTE 1
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $24 - 34$ Hourly