Enterprise Quality Specialist, FT, Day

Inspire health. Serve with compassion. Be the difference.

Job Summary

Accountabilities

• Conducts regular, ongoing audits of patient records to ensure efficient registration processes are being followed in order to support an optimal patient experience. This includes review of demographic and financial information to facilitate timely payment. A further responsibility includes review of information that supports the clinical team with health equity and the social determinates of healthcare. This information is subject to review by The Joint Commission and DHEC. - 30%
• Monitors in-baskets and work queues for errors and needed corrections. Appropriately assigns correction tasks to end-users, providing instructions and education. Audits process and follows up to assure correction is completed and cases are closed according to system and departmental policy and procedure. - 10%
• Performs as a Subject Matter expert for Patient Access. Demonstrates proficiency in resolving Patient and Account work queues in assigned to Patient Access in order to expedite timely claims payment and reduce denials. Maintains working knowledge of training requirements, regulations, policies and procedures involved in the primary functions of Patient Access. - 10%
• Investigates, analyzes and assesses the root cause and scope of identified deficiencies. Provides feedback to Patient Access Leadership in support of continuous quality improvement. Includes analyzing Coverage Detection files to determine gaps in collecting insurance information at the time of service. - 15%
• Monitors compliance with the provision of documents and forms as required by regulation. Compliance regarding documents and forms is subject to review by CMS, DHEC and the Joint Commission. These forms/documents include but are not limited to Advance Directives, Lewis Blackman Patient Safety Act, Notice of Privacy Practices, Patient Rights and Responsibilities, Permission to Treat, Limited Visitation Policy, Medicare Admission Questionnaire, Medicare Important Message and Medicare Outpatient Observation Notice. Lack of compliance can create a regulatory finding or jeopardize participation with CMS. - 10%
• Develops and conducts initial and ongoing training programs needed to improve the quality and integrity of data including but not limited to record accuracy, customer service and user support. Develops and maintains training materials and courseware. Assists in information system testing and implementation as appropriate. Participates in facility Patient Access Team Meetings to provide targeted education and mitigate documented deficiencies. Assists with the assessment and revision of policies and procedures to prevent recurring problems. - 15%
• Maintains a working knowledge of third party payment requirements, including (as applicable) Medicare, Medicaid, managed care organizations, private insurers, and worker's compensation carriers. Provides timely education to inform team members of relevant changes and developments in payor requirements. Proactively pivots to meet the changing needs of payor requirements to maximize cash flow for the organization. - 10%

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, director or executive.

Minimum Requirements

• High School diploma or equivalent

Knowledge, Skills or Abilities

• Ability to prioritize and organize work activities appropriately in a fast-paced environment with attention to detail.
• Experience with Epic or other electronic medical record
• Ability to integrate in an environment that focuses on an optimal patient experience, accountability, collaboration, team member participation, and effective communication, both written and oral.
• Practice and adhere to Prisma Health Behavior Standards.

Required Knowledge & Skills

• Basic Computer Skills
• Knowledge of office equipment (fax/copier)
• Proficient computer skills including database, data entry, word processing and spreadsheets.
• Mathematical Skills

Work Shift

Location

Facility

Department

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.