Brault

QA Engineer

• Audit daily work completed by billing staff, including claim submissions, follow-up activities, and collection efforts
• Review account documentation, actions taken, and billing outcomes within the billing system for accuracy, completeness, and compliance
• Identify errors, discrepancies, and trends affecting reimbursement, operational efficiency, or regulatory compliance
• Provide audit findings, feedback, and recommendations to billing staff and leadership
• Monitor, address, and audit special projects and programs, including credit card chargebacks, high-priority payer follow-up, and AB75
• Collaborate with team leads, supervisors, and managers to develop and refine policies, procedures, and workflows
• Assist with staff training on documentation standards, payer requirements, billing procedures, and industry best practices
• Participate in quality assurance initiatives and prepare reports for leadership
• Maintain current knowledge of industry regulations, payer policies, and billing software updates
• Support internal and external audit requests by gathering documentation, performing reviews, and responding to inquiries
• Perform manual tasks within Cross Workflow, including AR Support Requests and AR Follow-Up Requests
• Address high-priority Patient Services emails concerning invoices involving legal representation and time-sensitive deadlines
• Conduct compliance audits as assigned or requested

Accounts Receivable Quality Assurance Auditor

Patient Access Specialist

• Review, verify, and complete missing registration and insurance information on electronically received encounters
• Apply and correct billing details according to insurance carrier requirements and company policies
• Manage multiple client accounts according to assigned volume and productivity expectations
• Monitor and report low volumes, missing service dates, and missing insurance or payer information
• Use RICA coding application and AthenaIDX to update and correct demographic records
• Resolve demographic, insurance, and Patient Access-related errors, edits, and rejections
• Conduct verification checks and assign accurate payer information to support timely billing
• Take ownership of Level 2 escalations from the offshore team and resolve issues preventing claim submission
• Provide feedback and trending observations to the PA & EDI Supervisor
• Process work within two business days and notify the supervisor when not on target
• Complete daily production records accurately and on time
• Communicate workflow deviations and escalate issues affecting daily submission or month-end close
• Collaborate with Billing, Coding, Enrollment, EDI, and Leadership teams
• Participate in training, process improvements, and compliance with payer guidelines and internal workflows
• Adhere to company policies, safe work habits, confidentiality, and business standards

Medical Billing and Coding

• Oversee adherence to the Company’s compliance program using OIG Compliance Program Guidance for Third-Party Medical Billing Companies
• Assist the General Counsel in implementing and leading the Company’s compliance committee
• Improve efficiency and quality of services and reduce vulnerability to fraud, abuse, waste, and other risks
• Investigate, review, and respond to compliance issues, concerns, and complaints
• Review governmental health plan publications and arrange training about relevant changes
• Revise the compliance program in light of changes in company needs, laws, and payer policies
• Review employee certifications and standards-of-conduct compliance
• Develop, coordinate, and participate in compliance education and training programs
• Coordinate personnel and provider screening against the Cumulative Sanction Report
• Coordinate internal compliance reviews and monitor departmental activities
• Design and coordinate internal investigations and corrective actions
• Develop policies encouraging reporting of suspected fraud and improprieties without retaliation
• Process Medicare pre- and post-payment audits
• Process patient complaints and disputes involving possible compliance or provider service problems
• Research and develop answers to coding or billing situations with the Vice President of Strategy and Integrity
• Establish and perform internal reimbursement-coding audits
• Report internal audit findings to leadership bi-monthly
• Track error rates and ensure improvement or outline further steps
• Provide pertinent new and deleted CPT code lists for client fee schedule updates
• Troubleshoot coding issues for business associates and internal personnel
• Communicate with payers regarding prepayment review resolution
• Review accounts and determine resolution methods for prepayment reviews
• Provide quarterly compliance training on new issues and identified deficiencies
• Assist with training and troubleshooting for payment deficiencies
• Manage payer appeals specialist

Medical Billing Compliance Manager

Compliance

• Assure that the Company, its officers and management, employees, business associates, and clients adhere to applicable government law, regulations, policies, and procedures
• Oversee adherence to the Company’s compliance program using OIG Compliance Program Guidance as a guide
• Assist the General Counsel in implementing a compliance committee and lead and conduct meetings
• Establish methods to improve efficiency and service quality and reduce vulnerability to fraud, abuse, waste, and other risks
• Investigate, review, and respond to compliance issues, concerns, and complaints
• Review governmental health plan publications and circulate or arrange training about relevant changes
• Periodically revise the compliance program based on changes in company needs, laws, and payer policies
• Review employee certifications and ensure standards of conduct are received, read, and understood
• Develop, coordinate, and participate in compliance education and training programs
• Coordinate personnel and provider checks against the Cumulative Sanction Report
• Assist operations managers with internal compliance reviews and monitor departmental activities
• Design and coordinate internal investigations and corrective actions
• Develop policies encouraging reporting of suspected fraud and improprieties without retaliation
• Process Medicare pre- and post-payment audits
• Process patient complaints and disputes involving possible compliance or provider service problems
• Research and develop answers to difficult coding or billing situations
• Establish and perform internal reimbursement-coding audits
• Report internal audit findings to Leadership bi-monthly
• Track error rates and ensure improvement or outline further steps
• Provide pertinent new and deleted CPT code lists for client fee schedule updates
• Assist business associates and internal personnel with coding troubleshooting
• Communicate with payers regarding prepayment review resolution
• Review accounts and coordinate personnel needed to resolve prepayment reviews
• Provide quarterly compliance training
• Assist with training and troubleshooting for payment deficiencies

Compliance Manager

Provider Enrollment Specialist

• Complete Medicare, Medi-Cal, and other governmental provider enrollment application packets, not limited to California
• Complete non-governmental provider enrollment application packets, not limited to California
• Follow up routinely and confirm status of physician enrollment applications
• Maintain client/physician confidentiality
• Maintain effective communication and professional interaction with clients and physicians
• Navigate governmental and non-governmental websites