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. Required Skills Minimum Education: + High School Diploma : A high school diploma or equivalent (GED) is typically the minimum educational requirement for entry-level positions. Although a high school diploma is the minimum requirement, employers often look for candidates with specific skills or certifications, such as: + Medical Terminology Knowledge : A basic understanding of medical terminology, which can often be gained through self-study, coursework, or certification programs. + Experience or Training : Some positions may require previous experience in a healthcare setting, such as working in patient registration, insurance verification, or clerical support in a medical office. + Certifications : While not always required, certifications related to patient access or medical office administration (such as Certified Healthcare Access Associate (CHAA)) can be beneficial. + Technical Skills : Proficiency with computer systems and electronic health record (EHR) software is important. This might include understanding healthcare management software, Microsoft Office Suite, and data entry. + Strong Communication Skills : Both verbal and written communication skills are essential, as the role involves interacting with patients, medical staff, and insurance providers. + Attention to Detail : Quality assurance roles require close attention to detail to identify errors or areas for improvement. + Basic Knowledge of Healthcare Regulations : Familiarity with healthcare compliance standards such as HIPAA (Health Insurance Portability and Accountability Act) can be helpful. Required Experience + Recent graduate or up to 2 years of experience in a healthcare setting, preferably in quality assurance or a related area. + Experience with reviewing and analyzing demographic information is preferred. + Exposure to conducting audits and inspections within a healthcare environment. + Participation in quality assurance or performance improvement committees or projects. +