Overview
Quality Analyst II Jobs in Raleigh, NC at Mallinckrodt
Job Title:
Remote AR Quality Assurance (QA) Specialist – Outpatient Clinics (CCM & RPM)
Location:
Remote
Salary Range:
$45,000 – $55,000 per year
Job Summary:
The Remote AR Quality Assurance (QA) Specialist for Outpatient Clinics (CCM & RPM) is responsible for auditing and evaluating billing accuracy, focusing on chronic care management (CCM) and remote patient monitoring (RPM) services. This role oversees the claim submission process, identifies and analyzes denial trends, and collaborates with team members to implement quality improvements that optimize revenue cycle performance. The ideal candidate has in-depth knowledge of CMS guidelines, coding rules for CCM/RPM, and strong analytical skills to drive process enhancements and maintain compliance—all in a remote working environment.
Key Responsibilities:
1. CCM & RPM Billing QA
Perform regular reviews of patient claims and documentation for CCM (e.g., 99490, 99439, etc.) and RPM (e.g., 99453, 99454, 99457, 99458) codes, ensuring compliance with payer and CMS requirements.
Validate time-based service reporting, patient eligibility, and appropriate coding.
2. Denial/Reject Analysis
Investigate denials or rejections specifically related to CCM/RPM services; identify patterns and root causes (e.g., coding errors, incomplete documentation).
Prepare denial trend reports and disseminate findings to billing and clinical teams.
3. Process Improvement & Training
Recommend workflow enhancements to minimize claim errors and re-submissions.
Develop and conduct virtual training sessions for billing/coding staff and clinicians on updated CCM/RPM regulations and documentation standards.
4. Compliance & Regulatory Adherence
Maintain up-to-date knowledge of Medicare, Medicaid, and commercial payer regulations for CCM/RPM.
Ensure all billing processes comply with HIPAA and applicable federal/state healthcare regulations.
Maintain meticulous QA documentation for audit and compliance purposes.
5. Documentation Review & Accuracy
Verify accuracy of clinical documentation, time logs, and patient consent forms required for CCM/RPM billing.
Work with clinical staff to correct documentation deficiencies and reinforce proper reporting protocols.
6. Reporting & Stakeholder Communication
Generate and present monthly/quarterly QA reports highlighting denial rates, error causes, and recommendations.
Collaborate cross-functionally (billing, coding, clinical) to establish best practices and drive revenue cycle improvements.
7. Technology & Software Utilization
Utilize practice management systems, EHRs, and billing software to track, audit, and report on CCM/RPM claims.
Proactively propose system configuration changes to enhance quality controls.
Qualifications & Skills:
Education & Experience
Associate’s or Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field.
2–4+ years of healthcare billing, AR, or revenue cycle experience—preferably handling CCM and RPM claims for outpatient clinics.
Technical Expertise
Proficiency in Medicare billing rules, CMS guidelines, and payer-specific policies related to CCM/RPM.
Familiarity with electronic billing platforms, EHRs, and Microsoft Office tools (e.g., Excel for data analysis).
Analytical & Problem-Solving Skills
Proven track record of identifying denial trends, performing root cause analysis, and implementing effective solutions.
Communication & Training
Strong written and verbal communication skills, comfortable with virtual collaboration tools (e.g., Zoom, Teams).
Experience creating and delivering remote training materials is preferred.
Attention to Detail & Organization
Skilled in reviewing coding/documentation for accuracy, maintaining organized QA records, and meeting deadlines.
Compliance Mindset
Thorough understanding of HIPAA regulations and commitment to patient data confidentiality.
Work Environment & Benefits
Remote Position: Work from home with occasional virtual team meetings and periodic check-ins.
Working Hours: Standard business hours, with flexibility for time zone differences as applicable.
Job Type: Full-time
Pay: $45,000.00 – $55,000.00 per year
Schedule:
8 hour shift
Monday to Friday
Work Location: Remote
Title: Quality Analyst II
Company: Mallinckrodt
Location: Raleigh, NC
