Quality Assurance Collections Specialist

Wet Willie's; Miami (FL); On-site; USD 52,000 - 66,000; Full time

Benefits offered by this job

Certifications in QA a plus

Job summary

Wet Willie's in Miami, FL seeks a Quality Assurance Collections Specialist to audit collectors and ensure denials and no responses are accurate. You will develop, monitor and improve corrective actions within the collections department to uphold quality standards.

Key duties include drafting QA policies, evaluating data, and reporting outcomes. Strong knowledge of insurance payment regulations, HIPAA, and Excel is desirable. This role emphasizes detail, compliance, and collaboration across teams.

Qualifications

• Strong understanding of insurance payment regulations, including reimbursement schemes, coinsurance and deductibles.
• Working knowledge of HIPAA regulations and compliance.
• Experience with audits, quality assurance, and process improvement.
• Ability to analyze quality data and identify corrective actions.

Responsibilities

• Achieve or exceed department goals and support director directives.
• Develop, monitor and implement corrective and preventive actions.
• Draft QA policies and procedures for the collections team.
• Interpret and apply quality assurance standards across audits.
• Evaluate adequacy of QA standards and audit findings.
• Document internal audits and quality activities.
• Investigate customer complaints and non-conformance issues.
• Collect and report statistical quality data.
• Coordinate training needs based on QA findings.

Skills

Attention to detail

Multitasking

Data analysis

Verbal communication

Written communication

Planning & organizing

Team collaboration

Education

BS/BA or equivalent

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Job 158124 - Quality Assurance Collections Specialist
Miami, FL

The Quality Assurance CollectionsSpecialistis responsible for auditing Collectors and ensuring they are working denials and no responses accurately. This position is responsible for developing, recommending and monitoring corrective and preventive actions within the collections department.

Primary Objective

The primary objective of the Quality Assurance CollectionsSpecialistis to ensure the services of the collections department meet the established standards for quality including accuracy, efficiency, and competency.

Requirements

General Areas of Responsibility

• Achieve or exceeddepartment goals as defined by the department director
• Implements initiatives and strategies to reduce errors
• Draft quality assurance policies and procedures
• Interpret and implement quality assurance standards
• Evaluate adequacy of quality assurance standards
• Devise sampling procedures and directions for recording and reporting quality data
• Review the implementation and efficiency of quality systems
• Document internal audits and other quality assurance activities
• Investigate customer complaints and non-conformance issues
• Collect and compile statistical quality data
• Analyze data to identify areas for improvement in the quality system
• Develop, recommend and monitor corrective and preventive actions
• Prepare reports to communicate outcomes of quality activities
• Identify training needs and organize training interventions to meet quality standards
• Evaluate audit findings and implement appropriate corrective actions
• Assure ongoing compliance with quality and industry regulatory requirements

Required Knowledge, Skills and Abilities

• Excellent working knowledge of insurance carriers' payment regulations including various reimbursement schemes, coinsurance and deductibles, and contractual adjustments
• Knowledge of Medicare, managed care and commercial insurances
• Working knowledge of HIPAA regulations and compliance
• Knowledge of modifiers and their proper use required
• Works with payers to determine reasons for denials, corrects and reprocesses claims for payment in a timely manner
• Maintains relationships with insurance companies
• High attention to detail and the ability to multi-task
• Possess a working knowledge of Microsoft Outlook, Word, and Excel
• Strong verbal and written communication skills
• Data collection, management, and analysis
• Problem analysis and problem solving
• Ability to plan and organize
• Ability to make decisions
• Ability to work with multiple teams

Qualifications

• Combination of education and industry experience may be considered in lieu of BS/BA

Certifications in Quality Auditor, Quality Engineer, Quality Improvement Associate, and/or Six Sigma a plus

• Quality inspection, auditing, and testing experience a plus
• Knowledge of tools, concepts and methodologies ofQA
• Knowledge of relevant regulatory requirements
• Experience with implementation of corrective action programs