Healthcare Access Quality Analyst

Cooper University Hospital•Camden, NJ

20h•Onsite

About The Position

Manages a comprehensive HCA registration compliance integrity system and works toward goals and objectives for optimizing departmental performance and denial mitigation. Has a sound understanding of the payor policies related to denials and appeals process for denials deemed within Healthcare Access scope. Reviews and analyzes denial data for all denials occurring within the scope of HCA to determine denial trends and helps develop remediation plans and/or workflow resolutions. Presents denial metric driven information and workflow opportunities to Healthcare Access Leadership. Reviews and analyzes Notice of Admission submission to ensure we are submitting within payer driven requirements. Analyzes IP Only CPT codes for scheduled procedures to help identify best practice to identify and ensure proper authorization is obtained for the CPT code and site of service. Develops and maintains Executive Summary for Medicare Compliance Reports and collaborates with leadership on trends and opportunities for compliance within the IMM, MOON, and MSPQ collection process. Collaborates with Epic IT to ensure optimization of Epic Registration Dashboards for quality and productivity. Collaborates with Revenue Cycle University to develop annual CLN’s and quality assurance processes for all HCA Team Members. Develops and monitors EPIC reports and work queues to ensure timely response to denied cases and appeals and provides follow-up on cases until resolution has been achieved. Evaluates trends found in Epic DNB, Claim Edit, and Patient work queues and helps develop remediation plans for leaders to deliver to front end users. Assists in the on-going support of data collection, analysis, and developing/implementing new strategies to ensure an effective registration process. Participates in the development of documents to drive quality improvement, including the design of quality monitoring forms and quality standards. Documents and updates policy, process, procedures, guidelines, and training materials. Develops and maintains positive, collaborative, supportive working relationships with all members of the organization. Serves as a Subject Matter Expert on all areas within the scope of HCA. Provides support to all HCA in Camden and Cape May. All other duties as assigned by HCA Leadership.

Requirements

Minimum four years’ experience preferred in hospital, ambulatory, patient access, or related revenue cycle experience.
Demonstrated ability to research, collect, and present information.
Strong computer skills; proficiency with Microsoft Office suite.
Thorough understanding of ICD-10, CPT codes, HCPCS codes.
Epic User Web / Optimization skills required.
Excellent interpersonal skills as well as superior writing skills.
Deadline oriented; ability to work independently and in a team environment.
Ability to manage multiple complex and concurrent projects.
Knowledge of Payor Portals & Policies
Knowledge of EPIC account, patient, and referral wqs

Nice To Haves

Bachelor’s Degree preferred.
HFMA certification or equivalent certification in NAHAM, AAHAM preferred.
Healthcare experience preferred.

Responsibilities

Manages comprehensive HCA registration compliance integrity system and works toward goals and objectives for optimizing departmental performance and denial mitigation.
Reviews and analyzes denial data for all denials occurring within the scope of HCA to determine denial trends and helps develop remediation plans and/or workflow resolutions.
Presents denial metric driven information and workflow opportunities to Healthcare Access Leadership.
Reviews and analyzes Notice of Admission submission to ensure we are submitting within payer driven requirements.
Analyze IP Only CPT codes for scheduled procedures to help identify best practice to identify and ensure proper authorization is obtained for the CPT code and site of service.
Develop and maintain Executive Summary for Medicare Compliance Reports and collaborate with leadership on trends and opportunities for compliance within the IMM, MOON, and MSPQ collection process.
Collaborate with Epic IT to ensure optimization of Epic Registration Dashboards for quality and productivity.
Collaborate with Revenue Cycle University to develop annual CLN’s and quality assurance processes for all HCA Team Members.
Develops and monitor EPIC reports and work queues to ensure timely response to denied cases and appeals and provides follow-up on cases until resolution has been achieved.
Evaluate trends found in Epic DNB, Claim Edit, and Patient work queues and help develop remediation plans for leaders to deliver to front end users.
Assist in the on-going support of data collection, analyzation, and developing/implementing new strategies to ensure an effective registration process.
Participate in development of documents to drive quality improvement, including the design of quality monitoring forms and quality standards.
Document and update policy, process, procedures, guidelines, and training materials.
Develops and maintains positive, collaborative, supportive working relationships with all members of the organization.
Serve as a Subject Matter Expert on all areas within the scope of HCA.
Provides support to all HCA in Camden and Cape May.
All other duties as assigned by HCA Leadership.