Description
*** Must have specific knowledge of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, and billing compliance rules ***
Summary of Position:
The Patient Access Quality Assurance position will be responsible for completing monthly Quality Assurance to ensure that all assigned department team members meet all pre-determined metrics. The position will partner with various departments and leaders to ensure that opportunities and trends found during their Quality process is communicated and trained. The Patient Access Quality Assurance Representative must maintain full knowledge of the business process, operational workflows, and state regulations. This position will collaborate with the front line management team to implement success action plans to improve the overall quality metrics and provide excellent customer service.
Qualifications
Education:
• High School Diploma or GED preferred
Experience:
• Must have specific knowledge of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, and billing compliance rules.
• Strong working knowledge of hospital and physician billing and coding rules and guidelines.
• Strong knowledge in Revenue Cycle data to include claims and reimbursement data, inpatient and outpatient clinical data.
• Working knowledge of government and commercial payers, insurance contract analysis, and denial data.
• Strong problem-solving skills with the ability to prioritize and delegate multiple tasks.
• Exceptional verbal and written communication skills and the ability to professionally interact at all levels within the organization and with external partners/contacts is key.
• Must demonstrate strong computer skills, including spreadsheet, word processing, and database applications.
• Knowledge of Epic software and reporting platforms preferred
Knowledge/Skills/Abilities:
• Ability to manage multiple tasks.
• Ability to problem solve and create workable solutions from available information.
• Strong ability to research complex state and federal guidelines, both for government and commercial payors.
• Willingness to engage and assist in the education of staff across service lines.
• In depth knowledge of areas involving authorization, coding, billing, and reimbursement.
• Ability to monitor and prioritize tasks and issues throughout a given workday.
• Strong communication skills
Certifications/Licensure:
• NAHAM CHAA, HFMA CRCR preferred
Physical Demands
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 frequently required to walk, stand, sit, and talk or hear.
• The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.
• The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
• Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
• The employee must occasionally lift and/or move up to 25 pounds.
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.
• Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.
• Occasional travel to various health system locations.
Essential Functions
1. Performs quality audits on registrations, authorizations, and good faith estimates performed in all Patient Access areas.
2. Assists with the creation process, including designing, building, and testing, of new or customized data reports as related to quality for Patient Access.
3. Understands the organization's performance expectations and tracks key performance indicators for all areas in the department
4. Reviews reports for all Patient Access areas and individual staff to pinpoint specific trends or areas for improvement
5. Analyzes and distributes report findings to various staff throughout the organization, including executives, directors, managers, and frontline staff
6. Meets with revenue cycle leaders on a regular basis to ensure quality standards are accurate and met, and makes adjustments if they are not.
7. Applies critical analysis to interpret data and uses that analysis to propose potential solutions to identified trends
8. Work with auditors and other outside agencies to provide Patient Access quality data timely.
9. Provide continuous training and works with other department leaders to ensure quality and timely registration and authorizations.
10. Gathers data for statistical, process improvement, and planning purposes.
11. Conducts complex research as requested by internal customers and/or senior management.
12. Assists in coordination of various audits and reporting out on audit results.
13. Responds to the needs of the department by performing other duties, as necessary
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