DQA Specialist

Description

Definition:

DQA Specialist is responsible for verifying patient demographics and health insurance coverage while ensuring that all documentation necessary for the billing of ambulance transportation claims is obtained promptly from field staff for all billable events.

DQA Specialist is responsible for effectively communicating with Call Takers, Dispatchers, Dispatch Shift Supervisors, Drivers, EMT’s, Field Supervisors, Director of Operations and other management and support staff to obtain documentation necessary for billing and compliance.

Specific Duties

• Thoroughly evaluates all documentation received from Operations personnel (example PCRs, PCSs), Dispatch personnel (example: CAD records, call types, priorities), and external customers (example: insurance and demographic information) and ensure any shortcomings or discrepancies are addressed prior to submitting documentation and information to the billing office.
• Should ensure that all items listed on the DQA Key Data Point Review Sheet are reviewed, present and accurate prior to submission.
• Audits PCRs to ensure compliance with local medical protocol and works in coordination with DQA Supervisor, billing, and operations.
• Cross references all PCRs with CAD data to ensure that all ambulance runs have appropriate documentation completed and submitted.
• Contacts healthcare facilities, public safety agencies and insurance companies to obtain additional information for completion of documentation for ambulance runs when necessary.
• At the direction of DQA Supervisor follows up on any records held in Hold Que’s to address any shortcomings or discrepancies within the areas of insurance verification, patient demographics, and clinical documentation issues.
• Ensures the security of all company computer systems by adhering to security procedures and utilizing appropriate passwords policies.
• Always maintains security and privacy of all confidential and proprietary company information in accordance with company policy.
• Always maintains security and privacy of all company and patient information in accordance HIPPA and all other local, state, and federal regulations.
• Notifies DQA supervisor or any lapses in documentation resulting in less than full compliance with company and HIPPA standards
• Reports to assigned shifts properly groomed and according to the company dress code.
• Ensures that work area is ready for use at the beginning of each shift and after shift. This includes making sure that work area is clean and organized and that all company documents are appropriately filed and secured according to local, state, and federal law, company policy and HIPPA regulations.
• Completes all duties in accordance with local, state, and federal law, EMS regulations and company policy.
• Demonstrates complete knowledge, understanding and compliance of company policies and procedures.
• At all times sets an example of professionalism and places customer service, compliance, and safety above all else.
• Performs other duties as directed by management.
  
  

Qualifications

Minimum Requirements:

• Must Possess High School Diploma or GED
• Must possess knowledge of medical documentation.
• Must possess knowledge of obtaining insurance coverage for patients and understanding Managed Care, Medicare, Medicaid verification.
• Must possess a high degree of personal integrity and responsibility.
• Must have the ability to simultaneously manage multiple activities with minimal errors.
• Must have the ability to work effectively with minimal supervision, using good judgment.
• Insurance Verification, Medical Records clerk, front desk healthcare coordinator experience very desirable.
  
  

Physical Requirement

• The ability to sit or stand for long periods of time.
• The ability to use a computer keyboard for extended periods of time.
• The ability to complete all job duties.