The Patient Access Quality Assurance Analyst is responsible for improving department operations by assisting with quality review of assigned patient accounts. This position will perform quality assurance checks on outpatient accounts to look for areas of opportunity that will decrease our insurance denial rate and increase the number of error-free claims processed by our Patient Financial Services Team. As part of the QA process, this position will use information received from Patient Access Management to review and correct as required. The Outpatient Quality Assurance Analyst must be comfortable with verbal dialogue regarding the outcomes of audits of calls, registrations, and other functions within Patient Access.

FUNCTIONAL DEMANDS

Reports to: Patient Access Manager

ORGANIZATIONAL EXPECTATIONS

Knows, understands, incorporates, and demonstrates the Jennie Stuart Health and client Mission, Vision, and Values in behaviors, practices, and decisions

Provides a positive and professional representation of the organization.

Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.

Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.

Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.

Participates in ongoing quality improvement activities.

Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.

Complies with organizational and regulatory policies for handling confidential patient information.

Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and TJC standards and/or standards from other accrediting bodies.

ESSENTIAL FUNCTIONS

Primary source to assist with the quality assurance processes for demographic and insurance information on patient accounts.

Review and correct accounts assigned for pre-determined defects.

Maintains current knowledge of insurance requirements communicated by email, memorandum, and educational efforts.

Minimizes 3rd party payer denials by verifying authorization of service by assuring accuracy on assigned accounts.

Understands insurance payer basics to be able quickly recognize errors to be corrected.

Have the ability to produce high quality, high volume, and beneficial quality reviews. Escalate identified opportunities, issues, and out-of-benchmark metrics to the Patient Access leadership team for additional investigation and action plan development

Performs other duties as assigned.