Patient Access Quality Assurance Representative - Full Time - Admitting

Barton Healthcare System•South Lake Tahoe, CA

23d•$57,158 - $82,992•Hybrid

About The 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.

Requirements

One to two years' experience providing administrative support in an office environment required.
Specific knowledge of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, and billing compliance rules required.
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.
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.

Nice To Haves

High school diploma or GED preferred
Knowledge of Epic software and reporting platforms preferred
Bilingual abilities preferred
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

Responsibilities

Provides consistently exceptional care at all times.
Performs quality audits on registrations, authorizations, and good faith estimates performed in all Patient Access areas.
Assists with the creation process, including designing, building, and testing, of new or customized data reports as related to quality for Patient Access.
Understands the organization’s performance expectations and tracks key performance indicators for all areas in the department.
Reviews reports for all Patient Access areas and individual staff to pinpoint specific trends or areas for improvement.
Handles amended surgery authorizations and extended stays, to obtain approval ensuring payment as well as filing appeals to overturn high dollar billing denials.
Edits claims to ensure proper billing on UB-04s and make corrections as needed.
Analyzes and distributes report findings to various staff throughout the organization, including executives, directors, managers, and frontline staff.
Meets with revenue cycle leaders on a regular basis to ensure quality standards are accurate and met, and makes adjustments if they are not.
Applies critical analysis to interpret data and uses that analysis to propose potential solutions to identified trends.
Works with auditors and other outside agencies to provide Patient Access quality data timely.
Provides continuous training and works with other department leaders to ensure quality and timely registration and authorizations.
Gathers data for statistical, process improvement, and planning purposes.
Conducts complex research as requested by internal customers and/or senior management.
Assists in coordination of various audits and reporting out on audit results.
Responds to the needs of the department by performing other duties, as necessary.