Description
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:
● One to two years' experience providing administrative support in an office environment required.
● Sspecific knowledge of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, and billing compliance rules required.
Knowledge/Skills/Abilities:
● ● 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 and ability to research and troubleshoot.
● 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
● Must have strong computer skills, including spreadsheet, word processing, and database applications.
● Knowledge of Epic software and reporting platforms preferred
● Ability to work independently, as well as part of a team, and effectively manage and prioritize conflicting demands.
● Superior organizational skills required.
● In compliance with patient safety standards, must be able to effectively communicate in English; Bilingual abilities preferred.
Certifications/Licensure:
● Certified Healthcare Access Associate (CHAA) certification through National Association of Healthcare Access Management (NAHAM) or Certified Revenue Cycle Representative (CRCR) certification through Healthcare Financial Management Association )HFMA) 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. Provides consistently exceptional care at all times.
2. Performs quality audits on registrations, authorizations, and good faith estimates performed in all Patient Access areas.
3. Assists with the creation process, including designing, building, and testing, of new or customized data reports as related to quality for Patient Access.
4. Understands the organization's performance expectations and tracks key performance indicators for all areas in the department
5. Reviews reports for all Patient Access areas and individual staff to pinpoint specific trends or areas for improvement
6. Handles amended surgery authorizations and extended stays, to obtain approval ensuring payment as well as filing appeals to overturn high dollar billing denials.
7. Edits claims to ensure proper billing on UB-04s and make corrections as needed.
8. Analyzes and distributes report findings to various staff throughout the organization, including executives, directors, managers, and frontline staff
9. Meets with revenue cycle leaders on a regular basis to ensure quality standards are accurate and met, and makes adjustments if they are not.
10. Applies critical analysis to interpret data and uses that analysis to propose potential solutions to identified trends
11. Works with auditors and other outside agencies to provide Patient Access quality data timely.
12. Provides continuous training and works with other department leaders to ensure quality and timely registration and authorizations.
13. Gathers data for statistical, process improvement, and planning purposes.
14. Conducts complex research as requested by internal customers and/or senior management.
15. Assists in coordination of various audits and reporting out on audit results.
16. Responds to the needs of the department by performing other duties, as necessary.
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