HEALTHCARE ACCESS QUALITY ANALYST

About the Role

Manages comprehensive Healthcare Access (HCA) registration compliance integrity system and works toward goals and objectives for optimizing departmental performance and denial mitigation. Has a sound understanding of payer policies related to denials and appeals process for denials within HCA scope.

• Reviews and analyzes denial data for all denials occurring within the scope of HCA to determine denial trends and helps develop remediation plans and/or workflow resolutions.
• Presents denial metric-driven information and workflow opportunities to Healthcare Access Leadership.
• Reviews and analyzes Notice of Admission submission to ensure compliance with payer-driven requirements.
• Analyzes IP Only CPT codes for scheduled procedures to identify best practices for proper authorization and site of service.
• Develops and maintains Executive Summary for Medicare Compliance Reports and collaborates with leadership on trends and opportunities for compliance within the IMM, MOON, and MSPQ collection process.
• Collaborates with Epic IT to ensure optimization of Epic Registration Dashboards for quality and productivity.
• Collaborates with Revenue Cycle University to develop annual CLN’s and quality assurance processes for all HCA Team Members.
• Develops and monitors EPIC reports and work queues to ensure timely response to denied cases and appeals, providing follow-up until resolution.
• Evaluates trends in Epic DNB, Claim Edit, and Patient work queues and helps develop remediation plans for leaders to deliver to front-end users.
• Assists in ongoing support of data collection, analysis, and development/implementation of new strategies to ensure an effective registration process.
• Participates in the development of documents to drive quality improvement, including designing quality monitoring forms and quality standards.
• Documents and updates policy, process, procedures, guidelines, and training materials.
• Develops and maintains positive, collaborative, and supportive working relationships across the organization.
• Serves as a Subject Matter Expert on all areas within the scope of HCA.
• Provides support to all HCA in Camden and Cape May.
• Performs all other duties as assigned by HCA Leadership.

Requirements

• Minimum four years’ experience preferred in hospital, ambulatory, patient access, or related revenue cycle experience.
• Demonstrated ability to research, collect, and present information.
• Strong computer skills; proficiency with Microsoft Office suite.
• Thorough understanding of ICD-10, CPT codes, HCPCS codes.
• Epic User Web / Optimization skills required.
• Excellent interpersonal and superior writing skills.
• Deadline-oriented; ability to work independently and in a team environment.
• Ability to manage multiple complex and concurrent projects.

Qualifications

• Bachelor’s Degree preferred.
• HFMA certification or equivalent certification in NAHAM, AAHAM preferred.
• Healthcare experience preferred.
• Knowledge of Payer Portals & Policies.
• Knowledge of EPIC account, patient, and referral work queues.

Benefits

Cooper offers full and part-time employees a comprehensive benefits program, including:

• Health, dental, vision, life, and disability insurance.
• Retirement plans.
• Attractive working conditions and opportunities for career growth through professional development.