RCM Coding Quality Assurance Manager

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The RCM Coding Quality AssuranceManager is responsible for defining, monitoring, and maintaining quality review processes and procedures in alignment with the requirements of the OneOncology’s RCM and Compliance Department. This role is responsible for advancing the quality review process and presenting findings to OneOncology Leadership and partner practices.

Responsibilities for Manager, RCM Coding Quality Assurance

• Lead the development of the quality review and audit plan, aligning priorities with organizational risk management, regulatory requirements and following internal policy and procedures.

• Oversee the strategic direction of the quality review program, including timelines, methodologies, and reporting standards.

• Provide insight and advice to OneOncology Leadership on quality review audits and trends.

• Oversee coder/biller pre-bill and performance improvement pre-bill reviews to ensure compliance standards are met with an accuracy rate of 95% or better.

• Oversee and mentor RCM Coding QA Auditors and/or outsourced QA vendor, fostering a culture of continuous improvement and excellence.

• Develop and deliver training materials to end users to improve performance and success rates.

• Manage and oversee internal and external personnel audits ensuring adherence to state, federal, and contractual requirements through quality reviews of claims and medical record evaluations.

• Direct the end-to-end management of quality audit projects from planning to completion, including oversight of sample selection, documentation review, and corrective action follow-up.

• Oversee the development and presentation of dashboards and quality review reports for OneOncology leadership and partner practices, including physicians.

• Lead special project initiatives for quality reviews, providing high-level support and follow-up, and ensuring successful execution under the strategic direction of the Director of RCM Coding and VP, RCM Delivery.

• Proactively monitor data quality and integrity to identify opportunities for quality improvement.

• Research, effectively apply and train employees on current billing and coding regulations, auditing, and professional standards.

• Other duties assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualifications for RCM Manager of Auditing

• CPC or other coding certification required

• Bachelor’s Degree or equivalent experience required

• CPMA certification preferred

• 5+ years of auditing and leadership combined experience required

• Strong communication and interpersonal skills

• Proficiency with Microsoft Office products

• Ability to meet deadlines

• Demonstrated success in using data to make decisions and drive behavior change to support organizations

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