Presbyterian Healthcare Services

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PATIENT ACCESS QUALITY ANALYST

at Presbyterian Healthcare Services

Posted: 3/23/2020
Job Reference #: 13095
Keywords: system

Job Description

Requisition ID
2019-13095
Category
Patient Registration and Supp
Location : Name
Presbyterian Kaseman Hospital
Default: Location : City
Albuquerque
Default: Location : State/Province (Full Name)
New Mexico

Overview

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Varied Days and Hours

Summary:
Under the direction of the Patient Access Supervisor, the Quality Analyst is responsible for monitoring and documenting registration quality in support of the departmental quality goals and initiatives. The Quality Analyst evaluates accounts and in-person contacts by Patient Access Representative. This team member participates in the design of all quality monitoring formats and quality standards. The Quality Analyst will fairly and consistently review the accounts and interactions with the Patient Access Representatives for accuracy and will coach each Representative for success in executing superior service and quality to our customers. The Quality Analyst will document the quality results and provides feedback and trend data to the Supervisor and Manager as appropriate. The Quality Analyst will audit and analyze Patient Access processes and accounts are completed according to State, Federal and local compliance and regulatory guidelines. Identified needed training for staff or the department to improve quality.
The Patient Access Quality Analyst must possess a strong knowledge of Medicare (CMS) guidelines, Compliance Regulatory guidelines applicable to Patient Access, and be fluent in insurance and Patient Access Processes. The Quality Analyst will act as a resource to staff regarding registration questions.

Responsibilities

Customer Service and Caring Practices:
*Ability to provide exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
*Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times and de-escalation processes.
*Ability to manage conflict and appropriately request the help of a supervisor when needed.
*Acts as mentor for new hires.
*Implement PROMISE and CARES behaviors in every encounter.
*Educates patients for whom they speak regarding insurance benefits and liabilities.
*Ensures accounts are financially cleared at time of service through account review. to alleviate patient concerns over hospital financial matters
Encounter Components:
*Performs the patient registration process. Manage the accurate collection of patient data which includes but is not limited to;
*Assures accuracy and completeness of patient registration information and assures trending and reports inconsistencies in performance
*Clear errors that can be resolved by analyst without needed departmental intervention.
*Document errors and communicate to staff for coaching and correction.
*Assure correction of errors within regulatory time frames.
*Track, trend, and analyze errors over time to identify areas for improvement requiring education, process improvement, other quality improvement and software deficiencies.
*Follow up on documented errors to assure timeliness of error resolution and seek assistance through chain of command to resolve outstanding issues and concerns.
*Use online and written policies and procedures and regulations to ensure accurate and consistent intake.
*Act as liaison between Patient Access and Business Office in resolution of issues that would negatively impact quality reimbursement or regulatory compliance.
*Responsible for maintaining departmental error resolution policies and procedures processes.
*Assure open and timely communications with all co-workers.
*Support Business operations with regards to meeting monthly departmental quality indicators.
*Monitor MSPQ Compliance.
*Participate in processes to assure registration clean-up of problems in order to assure compliance with billing regulations and requirements
*Performs tasks individually and as part of an assigned team
*Work with Patient Access Leadership to identify training opportunities and deficiencies
*Verify demographic and other financial information is obtained necessary for account completion.
*Obtain missing insurance information, to include policy number, group number, date of birth, and insurance phone number if not already identified in account.
*Review eligibility and benefits responses of electronic verification, ensuring correct payer was captured by Patient Access Representative.
*Review of accounts falling within Missing Reg Item WQ and RQA Error WQ and report trends back to supervisor to improve departmental quality.
*Monitor and track Data Quality program to ensure errors are corrected at time of service.
*Maintain appropriate records, files, and timely and accurate documentation in the system of record.
*Performs other duties as assigned.
Financial Accountabilities:
*Verify identified patient financial obligation amounts including residual balance if *applicable and ensure attempted collection.
*Ensure accounts are clean and ready for billing.
Patient Relations
*Complete any information missing from the account to ensure accuracy at time of visit.
*Transparency with patients through communication of interactions with Patient Access Representative
Quality Improvement:
*Perform assigned patient care responsibilities, which may include but not limited to:
*Cooperate fully in all risk management activities and investigations.
*Report promptly any suspected or potential violations to laws, regulations, procedures, policies, and practices, and cooperate in related investigation.
*Conduct all transactions in compliance with all company policies, procedures, standards, and practices.
*Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.
C.A.R.E.S Behaviors:
*Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
*Ability to coach and mentor other employees
*Effective communication skills, analytical and problem-solving skills

Qualifications

*A minimum of 4 years of work experiences in healthcare setting with 3 year of Patient Access and/or billing or 3 years prior auditing experience in any field.
*Previously passed Patient Access II, Patient Access III or Patient Access Specialist I, and Financial Advocate or Patient Access Specialist II advancement test
*Pass annual competency exam for all areas of responsibility.
*CHAA, CHAM or other industry equivalent certification preferred
*Strong understanding of insurance and financial processing of accounts.
*Extended understanding of medical terminology and billing codes (DRG, ICD-10, CPT, HCPCS)
*Proficient in EPIC ADT system
*Knowledge in Microsoft Office Products
*Requires extensive knowledge of the customer encounter process which may include registration, healthcare practices, financial guidelines, billing requirements and coordination of benefits.
*Ability to work independently, detail oriented, self-directed and work with individuals with diverse background.

Education:
Essential: * High School Diploma or GED

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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