Quality Control Representative

Responsibilities

• Audits ER, Main Admitting, Ancillary and Breast Center registration to ensure accuracy.
• Able to identify the guarantor, guarantor address, insured and next of kin information.
• Able to identify all insurance cards, HMO's, PPO’s, HMO/Medicare and Medi-Cal.
• Maintains effective workflow by reconciling prior day’s registrations against the census and OP reports.
• Prints a face sheet on any missing accounts.
• Reviews, corrects, verifies, and updates demographic, billing information to ensure that the account doesn’t hit the failed bill report.
• Ensures that all errors are corrected in the CPSI registration system before bill drop.
• Reviews bill-hold reports for admitting deficiencies and maintains communication with registration, business office and other departments.
• Distributes updated forms to business office, and nursing unit.
• Performs quality review of accounts, corrects errors and distributes face sheets to appropriate departments.
• Maintains registration accuracy within the admitting/ Registration departments.
• Maintains QA reports on every employee.
• Collects any unmet deductible/ co-payment/ co-insurance from the patient.
• Reviews the insurance benefits for copay amount.
• Communicates effectively in written and verbal form.
• Performs assigned projects, clerical responsibilities, and other related duties as assigned.

Qualifications

• High school graduate or GED equivalent required.
• Minimum of 3 years admitting/ registration and/or business office background.
• Strong customer service skills.
• Positive work ethic.
• Computer and typing skills required.
• Excellent interpersonal skills.
• Strong organizational skills.
• Ability to work independently; self starter.
• General knowledge of third party payors, PPO, HMO, POS, EPO, workers compensation, Medicare, Medi-Cal, and Ca-Optima preferred.
• Knowledge of insurance authorization/ tracking/ pre-certification preferred.
• Bi-lingual (English & Spanish) preferred.
• Medical terminology preferred.