Quality Auditor

Location: Pittsburgh, PA

Cardiac Management Solutions

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

 

Job purpose

The Compliance Analyst is an integral member of the reimbursement team and has primary responsibility to ensure compliance with all Centers for Medicare & Medicaid federal regulatory requirements.  This is achieved by performing daily account audits, responding to payer audits and Medicare appeals, identifying internal areas for improvement, review of patient accounts and interpreting CMS requirements.

Duties and responsibilities

  • Review patient accounts to ensure medical necessity has been met as per payor contracts as well as confirm correct diagnosis codes have been assigned to ensure accurate billing 
  • Obtain necessary documentation (medical order, clinical notes, patient agreement, etc.) in preparation for audit/appeal responses
  • Maintain contact with patient, physician office, and sales field to relay and/or obtain pertinent information and/or documents
  • Track/Monitor audit activity to summarize and communicate regular audit updates to senior/executive management
  • Quality evaluation of select claims to determine deficiencies; present findings and recommendations to executive management
  • Identify and resolve problems in a timely manner; gather and analyze information skillfully; utilize available tools and resources effectively
  • Develop and deliver training programs and presentations to staff as directed
  • Produce work with attention to detail to reduce typos and inaccuracies that can occur in a fast-paced setting
  • Ability to handle multiple tasks simultaneously under strict deadlines 
  • Perform other duties as assigned by Management

Qualifications

Qualifications include:

  • H.S. Diploma or equivalent required, Associate’s or Bachelor’s degree in nursing, business or related field preferred
  • 3-5 years’ experience in medical billing, coding and/or insurance verification
  • Superior oral and written communication and customer service skill
  • Experience in provider audits / appeals with all payer types
  • Proficiency in MS Office Suite

 

Working conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 The noise level in the work environment is usually quiet.

 

Physical requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Supervisory responsibility

None

 

AAP/EEO Statement

ZOLL is committed to fostering an inclusive workplace, where unique identities, backgrounds, cultures, perspectives and experiences are respected and valued.

Equal Opportunity Employer – Disability and Veteran

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