Manager, QA and RCM Training - Military veterans preferred

Rethink Behavioral Health is the leading global provider of online research-based resources to support individuals with developmental disabilities. Our behavioral health platform (http://RethinkBH.com) provides clinical, staff training and practice management tools for private ABA service providers. Due to autism insurance mandates sweeping the nation, our behavioral health division is experiencing unprecedented growth. Therefore, we are looking for the right person to join our billing service team. 

We are seeking a highly skilled and experienced Quality Assurance Manager to assess the quality of our Revenue Cycle Management (RCM) services, including billing, enrollment and credentialing, and verification of benefits service lines. The ideal candidate will ensure that our RCM processes meet all necessary quality and compliance standards. This role involves developing and implementing quality assurance policies, conducting audits, creating training materials, SOPs, providing training to staff, identifying and communicating payor changes and the impact to service lines, general operational functions (customer invoicing, closing accounts), and overseeing a team responsible for maintaining high standards of quality and compliance across RCM functions.

Key Responsibilities:

1. Quality Assurance Oversight:
   • Develop and implement quality assurance policies and procedures specific to RCM services.
   • Monitor and evaluate the effectiveness of quality assurance processes in billing, enrollment, credentialing, and verification of benefits.
   • Conduct regular audits and inspections to ensure compliance with industry standards and regulations.
   • Ensure RCM data is accurately reported across the organization weekly.
   • Assign health risk levels and identify common trends for the team to follow up on through training or by creating additional resources and materials.
   • Collaborate with RCM teams to identify and resolve quality issues in billing, enrollment, credentialing, and verification of benefits.
   • Implement continuous improvement initiatives to enhance operational efficiency in RCM processes across all service lines.
2. Training and Development:
   • Design and deliver training programs to educate staff on quality standards and procedures in RCM services.
   • Ensure all employees are adequately trained in quality assurance practices related to billing, enrollment, credentialing, and verification of benefits.
   • Evaluate the effectiveness of training programs and make necessary adjustments.
   • Create materials and train staff on new products that impact billing services.
3. Compliance Management:
   • Ensure compliance with all relevant laws, regulations, and industry standards related to RCM services.
   • Stay updated on changes in regulatory/payor requirements and adjust company policies accordingly and disseminate to teams.
   • Prepare and submit compliance reports to team.
   • Support client escalations in conjunction with Billing Service Mangers to identify root cause issues to decrease customer churn.
4. General Operations:
   • Ensure cohesive and efficient processes for customer invoicing and closing accounts
   • Maintain and manage Billing Operations queue for account access needs
5. Team Leadership:
   • Lead and mentor the quality assurance team within the RCM department.
   • Foster a culture of quality and continuous improvement within the organization.
   • Provide regular feedback and performance evaluations to team members.
   • Perform and oversee a team of people performing the outlined duties.

• Minimum of 5 years of experience in quality assurance, with at least 2 years in a managerial role within RCM services.
• Strong knowledge of quality assurance methodologies, tools, and processes specific to RCM.
• Excellent leadership and team management skills.
• Strong analytical and problem-solving abilities.
• Excellent communication and interpersonal skills.
• Knowledge of relevant regulatory requirements and industry standards in RCM.

• Experience in the healthcare industry, specifically in RCM services (Billing, E&C, VOB)
• Experience in billing Quality Assurance
• Experience in Training Curriculum Development
• Experience in Project Management
• Experience in managing a team

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