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The University of Washington is a renowned public research university with a main campus located just minutes from downtown Seattle, and additional locations in
Billing Compliance and Quality Control Specialist
Location
United States
Posted
104 days ago
Salary
$66K - $84K / year
No structured requirement data.
Job Description
Billing Compliance and Quality Control Specialist
University of Washington
Job Description The School of Medicine has an outstanding opportunity for a Program Operations Specialist to join their team. The University of Washington (UW) is proud to be one of the nation’s premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoy outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty. UW Medicine works to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty medical care to people of the region, and preparing tomorrow’s physicians, scientists and other health professionals. Within the large UW Medicine health system, the School of Medicine (SOM) is a world leader in biomedical research, with the largest biomedical research program at a public university based on National Institutes of Health funding and ranking among the top research universities internationally. The Clinical Trials Office (CTO) supports the clinical research mission of UW Medicine. The CTO is an operational unit within the SOM’s Office of Research and Graduate Education charged with providing multi-service support to clinical researchers bringing important new therapies to our patients in compliance with evolving regulatory requirements. The Billing Compliance & QC Specialist will perform comprehensive and independent final compliance review (Summary Review) of all documents related to research study funding, including the research study budget, protocol, contractual terms, informed consent, and other supporting documentation. The incumbent will additionally function as a subject matter expert with CTO production workflows and systems processes, and will offer suggestions for optimization strategies. This position will assist with training internal staff on processes and systems and will educate CTO customers on workflows and expectations. Ability to work collaboratively in a group setting in a fast-paced environment is crucial in this role. The Clinical Trials Office is a central clinical research operation with compliance responsibilities and services across the vast portfolio of clinical trials in UW Medicine. The CTO operation has direct impact on UW’s reputation with major global biotech and biopharma sponsors, the availability of funded clinical trial opportunities in the UW pipeline, and UW patients' access to novel therapies. In addition, the CTO plays a key role in mitigating institutional financial and reputational risks by ensuring strict compliance with CMS and FDA regulations and guidelines. The Billing Compliance & QC Specialist is a key position in maintaining a secure and fully compliant CTO operation. DUTIES AND RESPONSIBILITIES Workflow and Billing Compliance - 70% - Perform comprehensive and independent analysis of systems processes pertaining to CTO review workflows. - Determine appropriate workflow pathway for proper routing of studies through the start-up process. - Perform Pre-CTO Admin Tasks import process for study submissions. - Perform Pre-Activation Checks for studies prior to transition to the CTO Billing Team for RSH Activation in Epic. - Perform CTO Inbox Management functions in the Zendesk (ZD) Customer Service Management tool. - Review and perform tasks from various Clinical Trial Management System (CTMS) OnCore reports, related to multiple workflows. - Understand and exercise independent judgment and discretion in the interpretation and application of the Medicare Clinical Trial Policy, and all relevant UW Medicine clinical research budgeting and billing policies and procedures. - Perform comprehensive and independent final compliance review (Summary Review) of all documents related to research study funding, including the research study budget, protocol, contractual terms, informed consent, and other supporting documentation. - Review and finalize study Billing Grids, ensuring proper documentation of Coverage Analysis decisions. - Regularly update and work with OnCore, ZD, the CTO Database (CTODB), Epic, and other comprehensive electronic study documentation for each clinical research study, in compliance with UW policies, procedures and standards. - Analyze, interpret, and apply internal and external research billing policies, assisting faculty, study staff, and clinical managers in determining applicable review requirements and facilitating timely budget approval. - Provide excellent customer service and accurate guidance to clinical research study teams and keep them apprised of study status. - Track studies through multiple milestone points in the CTO production database to inform analytics. - Manage production tickets and communications regarding work performed in compliance with office policies, procedures, and standards. - Ensure electronic and paper study files are created, updated, stored, and maintained according to established office practices, customer service standards, and UW record retention policies, from initial study submission to study closeout and beyond. - Effectively collaborate with and communicate important information to external investigators and research teams at partner institutions (e.g., Fred Hutchinson Cancer Center and Seattle Children’s). - Contribute to the development of the CTO website content, training materials, and SOPs. - Participate in internal and interdepartmental project teams within UW Medicine as assigned. - Under the guidance of the Manager and Sr. Workflow Lead, provide training for new and existing team members. - Perform other clinical research finance-related duties, as required. Quality Check (QC) - 30% - Assist with implementing strategies to achieve and maintain the service and quality goals for the CTO Clinical Research Finance Team. - Offer suggestions for optimization strategies that contribute to CTO metrics and other analytics for internal and external audiences. - Assist with QC of workflows being performed by team members training in those workflows. - Assist with data QC to ensure accuracy and alignment across multiple systems (OnCore, Epic, Zendesk, CTO Database, etc.). MINIMUM REQUIREMENTS - A Bachelor’s degree in science, business, healthcare administration or related field and at least three years’ related experience or equivalent combination of experience and education. Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license/certification/registration. ADDITIONAL REQUIREMENTS - Ability to make positive contributions and work effectively and efficiently in a group environment. - Exceptional customer service skills. - Strong written and oral presentation skills. - Ability to communicate effectively with all levels of staff, faculty, management and collaborators. - Ability to effectively prioritize and organize work independently in a fast-paced, high-volume setting. - Ability to work effectively and efficiently in a group environment. - Demonstrated skill in using Microsoft Word, Excel, and Access. DESIRED QUALIFICATIONS - Experience working in OnCore or other CTMS system. - Experience working with an Customer Service Management (CSM) ticketing system tool, such as Zendesk. - Familiarity with electronic medical records and healthcare business systems. Experience working with web-based solutions. - Experience in academic health system operations or medical setting. Compensation, Benefits and Position Details Pay Range Minimum: $66,000.00 annualPay Range Maximum: $84,000.00 annualOther Compensation: -Benefits: For information about benefits for this position, visit https://www.washington.edu/jobs/benefits-for-uw-staff/Shift: First Shift (United States of America)Temporary or Regular? This is a regular positionFTE (Full-Time Equivalent): 100.00%Union/Bargaining Unit: Not Applicable About the UW Working at the University of Washington provides a unique opportunity to change lives – on our campuses, in our state and around the world. UW employees bring their boundless energy, creative problem-solving skills and dedication to building stronger minds and a healthier world. In return, they enjoy outstanding benefits, opportunities for professional growth and the chance to work in an environment known for its diversity, intellectual excitement, artistic pursuits and natural beauty. Our Commitment The University of Washington is committed to fostering an inclusive, respectful and welcoming community for all. As an equal opportunity employer, the University considers applicants for employment without regard to race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status consistent with UW Executive Order No. 81. To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 or dso@uw.edu. Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law.
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Role Description Performs moderately advanced benefits program administration and member assistance work. Work involves determining benefits eligibility, processing applications for benefits, and providing guidance to Benefit Coordinators with benefits eligibility inquiries. Works under moderate supervision, with some latitude for the use of initiative and independent judgment. The ideal candidate for this position will have a comprehensive understanding of employee benefits, strong problem-solving skills, excellent verbal and written communication skills, a commitment to customer service, enjoy interacting with people, and be comfortable working in a fast-paced and structured environment. Essential Duties and Responsibilities - Answers incoming inquiries (e.g. phone calls, emails, etc.) from Benefit and Billing Coordinators regarding benefit administration, eligibility, billing, and any other questions regarding employee benefits. - Contacts benefit coordinators to resolve potential issues that have been identified internally. - Clearly documents case activities, outcomes, and feedback received by members. - Proactively handles own caseload and shared work queues to ensure timely resolution of escalated issues while meeting service levels and quality standards. - Processes changes to employee and dependent TXHB offered benefits, demographics, and beneficiary information. - Builds effective working relationships with Benefit Coordinators and others at assigned groups. - Serves as a resource for Benefit Coordinators, guiding and mentoring them regarding TXHB benefit administration processes, policies, and procedures. - Conducts basic data reviews of cases and inquiries to identify recurring issues, knowledge gaps, or process breakdowns and recommends potential solutions to leadership. - Proactively identifies and reaches out to Benefit Coordinators to discuss ongoing benefits or eligibility trends related to individual group benefit administration challenges. - Collaborates with other internal teams and external vendors to resolve eligibility and billing questions or issues. - Provide direction to peers by assisting with trainings as directed by Supervisor. - Participates on cross‑functional project teams focused on implementing new clients, systems, or benefit programs by representing the advocate perspective and validating processes. - May review and provide feedback on AI-generated responses provided to group contacts. - May serve as a backup for cross‑departmental work, including supporting special projects, documenting and testing new or updated processes, assisting with trainings, and contributing to operational readiness activities during peak periods or program changes. Qualifications - Strong knowledge of eligibility requirements including Section 125 and COBRA rules. - Strong knowledge of MS Office and billing and enrollment software. - Strong problem-solving and research skills. - Ability to effectively communicate complex benefits administration subjects both verbally and in writing. - Effective time management, organization, and prioritization skills. - Advanced knowledge of TXHB products, benefit terminology, benefits design, and eligibility rules. - Ability to work in a team environment and perform multi-task job functions. - Strong service-oriented communication skills, including the ability to empathize with others and diffuse tense situations when needed. - Ability to convey a professional manner in dealing with others and maintain constructive working relationships. - Self-motivated to fulfill tasks, resolve issues promptly, and meet deadlines. - Ability to effectively work within rapidly changing circumstances as needed. Requirements - 1-2 years of work experience in a related field such as Human Resources or health insurance. - Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field is preferred. - Experience working in a service-oriented position, where customer satisfaction is a key performance indicator is preferred. Physical Demands - Ability to speak/hear clearly to communicate by phone or in person. - Ability to frequently stand, sit and walk. - Ability to frequently lift and/or move up to 15 pounds. - Prolonged periods of sitting at a desk and working on a computer. Flexible Work Arrangements - 100% Remote (MON-FRI) Work Schedule - 8:00 AM - 5:00 PM (MON-FRI)
Director of Enrollment
Government Executive Media Group LLCGovExec’s data and insights set the standard for depth, accuracy, and impact for government leaders and contractors. As the market-leading information and intent-based marketing platform, for over fifty years GovExec has empowered the government ecosystem to engage and support government leaders as they work to achieve their missions across federal, defense, and state and local agencies.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Professional Development Academy (PDA) is seeking a high-performing Director of Enrollment to help lead our customer acquisition and revenue growth targets. In this role, you will be responsible for maximizing sales potential in predefined territories by engaging prospects to build awareness of Academy products and services and converting prospects to sales. Additionally, you will sustain and enhance customer relations with existing and prior customers to drive rebooking of Academy participants. The Director of Enrollment is a seasoned expert who understands the market landscape, our products and services, talk-tracks and demos for prospect engagement, and efficiently maintains daily outbound call volumes and contract close rates, all of which are actively reported as part of the performance management system. The Director of Enrollment is also someone who is self-directed when it comes to building and executing marketing campaigns, follow-up plans, and reporting via succinct dashboards that illustrate TAM, progress toward goals, and effective rates of engagement. - Proactively engage to learn markets, prospects, and outreach tactics - Establish goals and objectives on a rolling basis - Well prepared for each day’s activities relative to other directors and deputies of enrollment - Achieve business success factors, including daily call volumes and weekly enrollment targets - Lead multiple marketing campaigns and outreach strategies simultaneously - Maintain clear (and complete) records of all outreach via CRM - Present dashboard reports of success factors weekly Qualifications - Business degree preferred or equivalent - Preferred five+ years of experience as a successful sales leader, ideally with SLED experience - Committed to continuous personal and professional improvement (especially from feedback) - Proven ability to drive the sales process from prospect to customer and share best practices - Desire to establish business relationships with a focus on leadership development - Strong business savvy and political intuition - Perpetual optimism and desire to get better and better - Self-directed with a strong sense of team collaboration - Proficient with MS-Office applications and databases - Very strong communication skills - Exceptional customer services skills Benefits - Medical, dental, and vision insurance plans - 401(k) retirement plan with company match - Open time off policy - Twelve weeks paid parental leave - Supportive, collaborative teams - Unique opportunity to help government officials from a private sector company - Expansive learning and development opportunities Commitment to Shared Values - Soul of Entrepreneurship - Culture of Inclusion - Force of Ideas - Spirit of Generosity Compensation The compensation range for this role is $60,000 to $82,000, including commission potential. Equal Opportunity Employment Government Executive Media Group, Inc. and its affiliates ("GovExec") are Equal Opportunity Employers. We do not discriminate against our applicants because of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other status protected by applicable law.
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Performs moderately advanced benefits program administration and member assistance work. Work involves determining benefits eligibility, processing applications for benefits, and providing guidance to Benefit Coordinators with benefits eligibility inquiries. - Answers incoming inquiries (e.g. phone calls, emails, etc.) from Benefit and Billing Coordinators regarding benefit administration, eligibility, billing, and any other questions regarding employee benefits. - Contacts benefit coordinators to resolve potential issues that have been identified internally. - Clearly documents case activities, outcomes, and feedback received by members. - Proactively handles own caseload and shared work queues to ensure timely resolution of escalated issues while meeting service levels and quality standards. - Processes changes to employee and dependent TXHB offered benefits, demographics, and beneficiary information. - Builds effective working relationships with Benefit Coordinators and others at assigned groups. - Serves as a resource for Benefit Coordinators, guiding and mentoring them regarding TXHB benefit administration processes, policies, and procedures. - Conducts basic data reviews of cases and inquiries to identify recurring issues, knowledge gaps, or process breakdowns and recommends potential solutions to leadership. - Proactively identifies and reaches out to Benefit Coordinators to discuss ongoing benefits or eligibility trends related to individual group benefit administration challenges. - Collaborates with other internal teams and external vendors to resolve eligibility and billing questions or issues. - Provides direction to peers by assisting with trainings as directed by Supervisor. - Participates on cross‑functional project teams focused on implementing new clients, systems, or benefit programs by representing the advocate perspective and validating processes. - May review and provide feedback on AI-generated responses provided to group contacts. - May serve as a backup for cross‑departmental work, including supporting special projects, documenting and testing new or updated processes, assisting with trainings, and contributing to operational readiness activities during peak periods or program changes. Qualifications - 1-2 years of work experience in a related field such as Human Resources or health insurance - Graduation from an accredited four-year college or university with major coursework in business administration, insurance, or a related field is preferred. - Experience working in a service-oriented position, where customer satisfaction is a key performance indicator is preferred. Requirements - Strong knowledge of eligibility requirements including Section 125 and COBRA rules. - Strong knowledge of MS Office and billing and enrollment software. - Strong problem-solving and research skills. - Ability to effectively communicate complex benefits administration subjects both verbally and in writing. - Effective time management, organization, and prioritization skills. - Advanced knowledge of TXHB products, benefit terminology, benefits design, and eligibility rules. - Ability to work in a team environment and perform multi-task job functions. - Strong service-oriented communication skills, including the ability to empathize with others and diffuse tense situations when needed. - Ability to convey a professional manner in dealing with others and maintain constructive working relationships. - Self-motivated to fulfill tasks, resolve issues promptly, and meet deadlines. - Ability to effectively work within rapidly changing circumstances as needed. Physical Demands - Ability to speak/hear clearly to communicate by phone or in person. - Ability to frequently stand, sit and walk. - Ability to frequently lift and/or move up to 15 pounds. - Prolonged periods of sitting at a desk and working on a computer. Flexible Work Arrangements - 100% Remote (MON- FRI) Work Schedule - 8:00 AM - 5:00 PM (MON- FRI)
