JOB SUMMARY The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.  The QA Specialist is responsible for the timely completion and overall completeness of a reviewer report. Completeness is determined by customer requirements, company best practices, and clinical accuracy. In addition, the QA Specialist participates in improving DS processes and works with the Manager to ensure high efficiencies are achieved. Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results. Shift hours: 12:00 pm - 8:30 pm EST MAJOR DUTIES & RESPONSIBILITIES Client Interaction - Provides regular report status updates to the client. - Evaluates the Quality of physician’s report and determines if the report will meet all client and jurisdictional standards; the QA Specialist is also responsible for ensuring that the clinical rationale supports the physician’s determinations. - Clarifies ambiguous report questions with clients. - Distribute final report back to client according to client specific requirements. - Receives, coordinates & executes all aspects of clarification & addendum requests from the client.  - Participates in phone calls OR meetings with client(s) when a report is in question. - Follow up with the client for any missing information that is pertinent to the referral.  Physician Interaction - Works directly with physicians to ensure that all client questions are answered and supported by clinical rationale. - Conduct regular follow up with the physician or their office staff to ensure an on-time delivery of the report.  - Compose and provide verbal or written feedback to the doctor regarding report quality.  - Compose and provide verbal or written requests to the physician or their office staff for clarifications.  - Receive written or verbal confirmation from the physician that a report has the doctor’s approval and ensures the doctor provides his/her signature for the final report. Report Analysis - Review each physician report for data accuracy including spelling, grammar & punctuation.  - Responsible for ensuring that all state requirements for reporting are met.  - Responsible for report format and adhering to each client’s specific requirements. - Must ensure that all client special handling instructions with regard to report completion and delivery are met. Additional Duties - May provide oversight to the work of the team members. - Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.  - Responsible for the final approval on cases for release to the client. - Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations. Other duties & special projects, as assigned and based on business needs.

• Uses ICD-10-CM and/or HCPCS/CPT codes to assign, validate, and/or work pre-bill coding edits for the following patient types: • Medical Oncology (Med-ONC), Radiation Oncology (Rad-ONC), Bone Marrow Transplant (BMT), Infusion & Injections, and multispecialty hospital-based outpatient clinics (Oncology, HepC, MS, Pulmonary, etc.) • Works pre-bill edits daily to resolve issues related to coding assignments, charge errors, and missed modifiers • Maintains or exceeds established productivity standard (minimum of 75 pre-bill edits cleared daily or a combination of daily charge capture and pre-bill edits) • Ensures that all assigned charges are captured timely and consistently within the 3-day charge goal • Performs coding audits for BCC coders upon request and as needed to reduce coding error trends • Utilizes the complete medical record documentation in code assignment, validation, and/or editing of codes

• Provide coding of medical records and any applicable supporting documentation. • Codes records to assign ICD-10, CPT, and modifiers in accordance with coding guidelines • Meets quality and productivity standards and deadlines/turnaround times • Assigns indicated account and claim data attributes as indicated (POS, revenue code, implant pricing) • Demonstrates thorough understanding of how work impacts the project/end customer • Recognize, interpret, and evaluate inconsistencies, discrepancies, and inaccuracies in the medical data received, and appropriate alerts and/or queries indicated by the party or supervisor • Reviews and correctly responds to AR tasks related to pre-claim edits pertaining to coding and post-submission denials • Demonstrates a good rapport and works to establish cooperative working relationships with all members of the team • Demonstrates willingness and flexibility in working additional hours or changing hours whenever required between normal business hours

• Learn everything other medical billing/coding institutions teach, plus specifics related to the unique needs of federally qualified health centers (FQHCs) and look-alikes. • Upon successful program completion and a passed exam, become certified in medical billing and medical coding. • Provide efficient and effective coding services on behalf of our member clients in accordance with Payer requirements and organizational policies, while ensuring compliance to all coding guidelines. • Abstract clinical data (diagnoses and procedures) from patient medical records and on-line patient data. • Review and interpret patient encounters for accurate code assignment of all relevant diagnoses and procedures. • Help fulfill the reimbursement needs of the member through review and recommendation or correct assignment of diagnosis and procedure codes which are critical to third party reimbursement. • Research and obtain necessary information from provider/office via Epic in-basket when necessary, per agreement. • Assist with research for denied claims. • Meet assigned productivity goals. • Establish and maintain positive working relationships with patients, payers, team members, clients and other stakeholders. • Maintain confidentiality of patient information, organization data and information, and in compliance with HIPAA regulations.