Quality Assurance Customer Service

Josef C. Darusz - MBA LSSGB

720-***-**** *******@*****.*** www.LinkedIN.com/in/jcdarusz

**** ******** *** ***, *** 304, Colorado Springs, CO 80924

RESULTS-DRIVEN BUSINESS LEADER WHO DELIVERS SUSTAINED EFFICIENCY AND LONG-TERM PEAK PERFORMANCE

Acumen & Skills

Dynamic Leadership & Management Skills

Discerning & Effective Problem-Solving

Data Analysis & Visualization

Thorough & Acute Attention to Detail

Quality Assurance Program Development

Internal Auditing Cycles & Ad-hoc Analysis

Compliance Monitoring & Reporting

Complaints Management

Accreditation / Provider site audits - compliance & readiness management

Effective Team Building, Coaching, & Mentoring, Including Remotely

Diverse audience presentation skills

Project Management / Successful Multitasking with Multiple Projects

Rapid SME level proficiency upskilling ability and new challenge/knowledge mastery

Internal And External Customer Relationship Management

Policy, Procedure, Desk-Instructions documentation development & maintenance

Onboarding & Annual Training curriculum development, deployment, & upkeep

Lean & Agile Process & Quality Improvement Methodologies & Process Mapping

Broad Computer Technologies & Standard Business Applications Proficiencies

(MS Office, Excel/VBA, Visio, Tableau, Epic, OnBase, QMS: MasterControl, Salesforce)

• Revenue Cycle Management (RCM) • Healthcare Billing & Collections • Internal Quality Assurance • Call Center QA • Operations Management • Healthcare Administrative Services • Customer Service • Business Analysis, Strategy, Planning • EMR & CRM Systems

Experience

Quality Assurance Supervisor – Order Review, Reimbursement & RCM, Accreditation & Compliance 2019-2023

Cochlear Americas, LLC. (Lone Tree, CO) – Auditory Implant & Medical Supply Manufacturer & Provider

Order Review, Reimbursement & RCM Quality Assurance: I was promoted after a year with Cochlear to form, hire, and lead the Reimbursement QA team. I continued development and management of the program, with a focus on enhancing order placement, clean claims submissions, reimbursement, and revenue cycle management operations. This involved overseeing QA audit reviews of over $150 million in orders and claims billables and remittances annually, producing coaching scorecards, audit files, and findings reports for multiple teams and departments including over 250 team members (Customer Service/Order Intake, Pre-Claim, and Billing/Collections RCM teams). Valuable metrics reporting and audit results were provided monthly to all leadership and their teams. I oversaw day-to-day QA operations which included audit reviews of order intake and pre-claim operations, claim processing & collections, inbound/outbound calls, and monitoring of key systems, performance metrics, and actual/potential risk indicators.

Accreditation & Compliance: Additionally, I co-managed the CMS Medical Supply Provider Accreditation Program, ensuring compliance with ACHC Standards (Accreditation Commission for Healthcare), DMEPOS Supplier and Quality standards, and all regulatory requirements. In 2020, for the QA work completed with teams and accreditation recertification with no adverse findings achieved, I received one of the annual president’s awards for service excellence, and led three of my senior team members to earn various or similar awards and nominations in subsequent years. I successfully led the QA team in achieving quality targets in alignment with CMS accreditation standards, consistently meeting or exceeding them each month.

Policy & Training Management: I played a pivotal role in enhancing operational efficiency and compliance within the QA, RCM, and accredited reimbursement services teams by spearheading the development and maintenance of formal standard operating policies, procedures, and desk instructions. This comprehensive effort involved partnering with various leadership team members, reviewing and refining over 80 policies and procedures, generating more than 700 pages of content and step-by-step walkthroughs, and ensuring their annual upkeep through the MasterControl QMS system over a span of 5 years. These initiatives significantly contributed to strengthening the organization's foundation for success and establishment of secure processes at the U.S. headquarters. Also developed was an onboarding program for new QA hires, resulting in successful autonomy, growth, and career development for my team.

Operations Impacts: During critical periods such as product launches, fiscal & calendar year-end, and the pandemic, I facilitated process improvements and efficiencies leading to significant increases in processed billables (meeting or exceeding targets year over year and by over 30% in the last two years); while maintaining peak efficiency through effective research and analysis with reported findings and process improvements implemented. Additionally, we ensured a less than 1% audit findings take-back and refund rate by 3rd party payor audits and post claims billing reviews. These analytically supported reimbursement findings led to teams exceeding forecasted financial expectations during the pandemic; posting growth as opposed to forecasted declines, and above compared prior year periods.

Communication and Collaboration: The successes achieved in this role were accomplished through high levels of succinct regular and real-time collaboration and communication. This included through various channels and feedback loops (including in MS Teams). Specifically, I conducted weekly team huddles, monthly team meetings, 1x1’s with direct reports, senior leadership, and cross-functional teams. Additionally, I actively participated in and facilitated monthly meetings with cross-functional business partners, quarterly business reviews, forecasting, strategy and planning, monthly quality improvement, and quarterly compliance meetings. This ensured a proactive and agile position of strength, synchronicity, and flexibility to meet the demands of organizational goals; including unforeseen circumstances, minimizing inherent business risks and identified exposure potentials.

Projects & Process Improvements: A number of other improvements were achieved in ad-hoc process audits for waste and loss prevention amounting to significant gap and process misuse elimination (over $2.2 million at risk) due to unclear elements of training and limited reporting and visibility. One such endeavor included my Lean Six Sigma Green Belt certification project which addressed the product returns and refunds process gaps (which was completed while maintaining daily primary role and team responsibilities over the course of 1 year). Timely reporting and cross-team-dependent visibility were significantly improved, demonstrating an over 70% increase in securing patient return/refund reasons to ensure sufficient process control, continuous improvement, and monitoring standards going forward. I was also involved in advising other teams on establishing an appropriate QA function/program for their respective non-reimbursement services departments. Additional various improvement projects in which I participated: multiple telephony system conversions, customer service call strategy training program recreation and redeployment, CRM and ongoing systems merges, annual accounting audits, work driver systems improvements, team management dashboards, special request audits.

Quality Assurance Specialist - Reimbursement & RCM 2018-2019

Cochlear Americas, LLC. (Centennial, CO) – Auditory Implant & Medical Supply Manufacturer & Provider

Starting in this role at Cochlear, I developed, implemented, and maintained a robust revenue cycle management and reimbursement services quality program. I worked closely with the Billing & Collections RCM teams to enhance processes, visibility, and performance. My responsibilities included overseeing and refining quality assurance activities, with a specific focus on monitoring and improving reimbursement collection efforts. I leveraged my expertise in performing audits and process analysis to ensure the highest level of quality in day-to-day operations. I developed audit evaluation forms and QA processes, maintained standard operating procedures, work instructions, and training materials, and closely monitored and analyzed claim and invoice activities. Additionally, I conducted audits of inbound and outbound communications, identified areas for process improvement, and recommended additional training as needed. This role contributed to faster claim resolution and an improved customer experience.

Quality Assurance Auditor - RCM 2014–2018

Quadax, Inc. (Middleburg Hts., OH) – Third Party Medical Billing & Software Development, Revenue Cycle Management

This role closely monitored productivity and quality standards, utilizing key performance indicators for identifying process deviations and continuous improvement opportunities in claim cycle operations. My responsibilities included targeted audits across various functional areas, such as billing, customer service, benefits investigation, prior authorizations, insurance appeals, payment processing review and remittance posting. This provided senior leadership at all levels with vital audit findings to close process gaps and provide necessary coaching visibility across 18 different organizational client groups quarterly. I specialized in appeals, fostering collaboration between management and production teams, strengthening clean claims and adverse adjudication resolution. Additionally, I played a vital role in educating management on the RCM QA protocols and reporting processes (including over-seas phone support leadership). My active engagement in QA improvement initiatives and rigorous QA testing led to enhanced organization-wide performance.

Patient Service Representative 2011–2013

The Cleveland Clinic Foundation (Twinsburg, OH) – Hospital, Primary, Specialty, Emergency Care, & Outpatient Surgery

In this multifaceted role, I managed a wide range of responsibilities encompassing multi-practice and call center scheduling, overseeing arrival and departure desk activities, handling patient intake, facilitating physician-patient-pharmacy documentation services, executing point-of-service activities, preparing visits, collecting co-pays, tracking patient records, and initiating patient training on the MyChart system. My duties extended to coordinating interpreter services, implementing privacy practices, and providing exemplary customer service. I was responsible for maintaining EMR data related to the master patient index, insurance, billing information, and eligibility services, including collecting referring physician information, radiology, and procedure schedules. Proficient in utilizing the Epic and OnBase software systems, I efficiently handled high-volume call center duties across all specialties. Additionally, I played a crucial role in training new team members, providing onboarding support, and actively contributing to process improvement initiatives.

Education

Master’s Degree – MBA Business Administration Cleveland State University (Cleveland, OH) aacsb accredited 2010

Bachelor of Arts – Business Administration & German (Dual Majors) Calvin College (Grand Rapids, MI) HLC Accredited 2008

Certifications

Lean Six Sigma Greenbelt 2022

Awards

Cochlear Americas, LLC. - President’s Service Excellence Award 2020

Diversity

Cochlear Americas, LLC. – American Headquarters Culture Champion 2020-2023

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