QA Specialist III

Role and Responsibilities

• Prepare and implement quality assurance policies and procedures based on client requirements.
• Perform routine quality assurance on overpaid claims of a complex nature while ensuring adherence to client requirements, policies and procedures.
• Possess a clear understanding of the identification and analysis of overpaid claims.
• Collaborate with Trend Management to identify solutions and efficiencies related to quality assurance workflow, procedures and reporting.
• Identify issues and make recommendations on improvements that will improve operational efficiency.
• Train, mentor, and assist new QA staff.
• Prioritize workload to meet deadlines and goals using guidelines established by manager.
• Always represent Trend and our clients in a professional manner
• Complete other tasks both routine and complex in nature, as requested by Manager.

Qualifications

• Bachelor’s degree in business, healthcare, or a related field preferred or equivalent work experience in the healthcare industry.
• Solid knowledge of overpayment recovery services.
• Strong analytical skills
• Strong communication and interpersonal skills, displaying the ability to connect and build relationships with payer clients, management, and peers.
• Team player with a strong desire to be an active long-term participant in the growth of the firm overall.
• Ability to learn quickly, make an immediate impact and provide value-added service.
• Attention to detail.
• Experience working under tight deadlines

Mental and Physical Demands

• This position will be exposed mainly to an indoor office environment and will be expected to work in or around computers and printers.
• The nature of the work is sedentary, and the employee will be sitting most of the time.
• Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
• Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Related Duties as Assigned

• This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
• Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.