Pacific Dental Services, LLC Analyst, Quality Improvement in Henderson, Nevada

Analyst, Quality Improvement

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Analyst, Quality Improvement

Pacific Dental Services® (PDS) partners with individual owner dentists across the U.S., providing them with business support services so they can stay focused on their passion: dentistry. PDS and its supported owner dentists offer career opportunities nationwide. Established in 1994, PDS has been ranked in Inc.’s 500|5000 list of America’s fastest-growing private companies for eight years in a row, and continues to grow. PDS is founded on a core set of values that guides our daily lives, distinguishes the strength and character of our organization and directs our critical decisions. At PDS and in our supported offices, we aim to be the very best at everything we do. Fortunately, that helps us attract the very best team members – and we hope you’ll be one of them.

Responsibilities:

The Analyst, Quality Improvement is responsible for performing reviews and auditing of tasks accomplished by the billers. This position has the sole responsibility to ensure that each audit performed is of the highest quality and meets the department and company criteria for consistency. The incumbent will review accounts on a weekly basis, organize meetings with team members and the Senior Manager, Training and Quality, to go through errors identified, maintain accurate and reliable reporting that contains audit scores of all team members. The Quality Improvement Analyst will also develop a communication plan that highlights potential causes of errors, and conduct training on development of team members to mitigate future errors.

  • Analyze and audit claims submitted by the billers to identify any inconsistencies.

  • Ensure all claims submitted meet the consistency and quality standards of the company.

  • Perform daily activities of auditing the patient claims billed to ensure accurate and maximum reimbursement for patient treatment from insurance carriers.

  • Confer with the management team to identify and resolve any noticeable patters of errors.

  • Submit confidential audit reports to management, to be reviewed and discussed to aid in skill development of the team and to ensure adherence to quality standards.

  • Direct and coordinate the training activities directly related to skill development and increasing the quality standards of the team.

  • Adheres to strict confidentially expectations.

  • Analyze Explanation of Benefits (EOB) statements and adjust accounts according to PDS claims processing criteria.

  • Review the Aging Collection Report ensuring accounts are properly billed to the insurance.

  • Communicate trends and suggestions to improve processes to ROC and Field Managers.

  • Oversee and interact with other PDS departments and team members in regards to certain administrative operations within practices. This includes but is not limited to plan credentialing, eligibility, fees, pre-authorizations, billing, auditing, and claims follow-up.

  • Report weekly to Sr. Manager of Billing Operations detailing accomplishments, areas for improvement, clear performance goals, and effectiveness of existing processes and systems.

  • Coach and mentor less experienced team members, and create environment for knowledge transfer and cross-training.

  • Seek out and identify efficiencies and develop systematic approach for process improvement. Effectively coordinate and communicate changes and enhancements with management.

  • Maintains an appropriate professional appearance and demeanor in accordance with Company policies.

  • Ensure compliance with Company policies, as well as State, Federal and other regulatory bodies.

Qualifications:

  • Minimum 4-6 years of related experience in dental or medical billing operations.

  • Bachelor’s Degree or higher in Business Management or a related field. In lieu of degree, +2 years of experience is required.

  • Knowledge of QSI software applications.

Desired:

  • Experience in a multi-regional healthcare, retail, or dental company.

  • Good understanding of how to read and interpret EOBs (Explanation of Benefits).

  • Prior customer service experience.

  • Prior experience in training of staff.

Your commitment to Pacific Dental Services® is the key to our success. In turn, we’ll reward you with a benefits package that shows we care about you, your family and your future. We encourage team members to develop their distinctive talents and strengths—and embrace an entrepreneurial spirit that rewards individual achievement.

Henderson, Nevada, US

Location: Henderson Support Center

Company Name: Pacific Dental Services

Pacific Dental Services (PDS) partners with individual owner dentists across the U.S., providing them with business support services so they can stay focused on their passion: dentistry. PDS and its supported owner dentists offer career opportunities nationwide. Established in 1994, PDS has been ranked in Inc.’s 500|5000 list of America’s fastest-growing private companies for eight years in a row, and continues to grow. PDS is founded on a core set of values that guides our daily lives, distinguishes the strength and character of our organization and directs our critical decisions. At PDS and in our supported offices, we aim to be the very best at everything we do. Fortunately, that helps us attract the very best team members – and we hope you’ll be one of them.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled