Patient Access Ops Analyst at None

Minimum Education
High School Diploma or GED (Required) Or
Bachelor's Degree (Preferred)

Minimum Work Experience
5 years Related patient accounting experience required, especially related to denial mitigation and root cause analysis (Required)

Required Skills/Knowledge
Excellent working knowledge of complex contract reimbursement methodologies including transplant, global, APR DRGs among others.
Proven analytical skills including ability to make recommendations based on financial analyses.
Excellent PC skills including advanced skill proficiency in Access and Excel spreadsheet analysis.
Ability to work in a team environment with other analysts, managers, and department leaders.
Proficiency in presentation of analytical results.
Demonstrates excellent organizational and problem-solving skills. Ability to communicate professionally with physicians, third party payers and other organization members relative to the coding principles, logic and process. Acts as a liaison between patient accounting, case management and patient access. Maintains confidentiality of the record content at all times.
Experience with professional service billing and coding; insurance eligibility verification and registration.
Demonstrated knowledge of managed care payer requirements in an acute hospital setting.
Demonstrated ability to facilitate team or group activities.
Excellent verbal and written communication skills.
Demonstrated ability to be flexible and to prioritize workload & decision-making skills.
Ability to analyze workflow for process improvement.
Strong organizational and coordination skills required.

Functional Accountabilities
Account Follow-up and Collections

• Ensure all assigned claims are followed up and/or appealed in a timely manner as per standard operating procedure (SOP); ensure maximum recovery of reimbursement.

• Perform Registration quality checks to ensure appropriate billing.

• Review charge reports daily; identify and correct any discrepancies.

• Provide leadership feedback in regard to any identified patterns or trends.

• Ensure written appeals are clear, concise and within timely appeal limits.

• Ensure appropriate supporting documentation is included with appeals.

• Analyze retracted payments to determine appropriate course of action to recover reimbursement.

• Prioritize work to facilitate payment of higher account balances.

Data Analysis and Issue Resolution

• Manage matrix of issues & resolutions including accountable stakeholders; ensure results and escalate issues as appropriate; regularly report updates and challenges to manager

• Conduct root cause analysis of issues reducing reimbursement & slowing payment cycle. Identify key issues and assist in tracking, trending and reporting.

• Present data and analysis clearly to all levels of staff and management.

• Meet with manager and outside departments to review issues and develop action plans.

• Assist in development of solutions, training & education guidelines to resolve issues and share data with staff and management.

• Appropriately engage and involve key accountable stakeholders in a collaborative manner.

• Research payer & CMS policies related to revenue cycle; identify & alert stakeholders of required changes; track and ensure completions.

• Develop KPIs and Dashboards on charge correction, charge processing, and registration for the organization.

• Produce reports for departments and senior leadership on charge correction, change processing, and registration trends, issues and opportunities for improvements.

• Work with Leadership to address any discrepancies or trends and implement process improvement.

Safety

• Speak up when team members appear to exhibit unsafe behavior or performance

• Continuously validate and verify information needed for decision making or documentation

• Stop in the face of uncertainty and takes time to resolve the situation

• Demonstrate accurate, clear and timely verbal and written communication

• Actively promote safety for patients, families, visitors and co-workers

• Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Non-Essential Function

• May perform other duties as assigned.

Organizational Accountabilities
Training Data Analysis

• Compile results of feedback tool and evaluate feedback trends.

• Compile training and development data and assist in recommending program/course modifications.

• Participate in identifying organizational training needs.

• Assist in determining priorities for training sessions.

• Assist in identifying resources to meet training objectives.

Organizational Commitment/Identification

• Partner in the mission and upholds the core principles of the organization

• Committed to diversity and recognizes value of cultural ethnic differences

• Demonstrate personal and professional integrity

• Maintain confidentiality at all times

Customer Service

• Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others’ ideas and opinions

Performance Improvement/Problem-solving

• Contribute to a positive work environment

• Demonstrate flexibility and willingness to change

• Identify opportunities to improve clinical and administrative processes

• Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

• Use resources efficiently

• Search for less costly ways of doing things

Organizational Accountabilities (Staff)
Organizational Commitment/Identification
Teamwork/Communication
Performance Improvement/Problem-solving
Cost Management/Financial Responsibility
Safety Apply Now