To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Quality Assurance (QA) Process Optimization Lead reports to the Sr. Manager with responsibility for improving the quality and efficiency of Corporate Business Services (CBS) and Corporate Professional Business Services (CPBS) operational processes through data gathering, analysis, quality assurance reviews, optimization and reporting. Leads aspects of the process optimization auditing operational workflows, revenue cycle processes throughout the health system which impact the accounts receivable. Identifies and structures new QA initiatives associated with new workflows. Provides leadership support through analyzing and identifying trends associated with problem areas within the revenue cycle. Seeks out and recommends potential solutions for risk areas which include the investigation of alternative workflow. Works with Pre-Service Department, Access, Billing/Collections, and HIM management staff to foster positive relationships enabling a collaborative approach to improving quality and workflow efficiencies. Recommends and develops new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department. Works collaboratively with IT, Epic and CBS Systems & Training teams for specified applications to identify work process improvements.
- 1. Achieves Health System process optimization objectives by leading process improvement teams and committees charged with system improvements through the use of analytic skills and knowledge of available data.
- 2. Evaluates the effectiveness of operations, utilizing knowledge of Epic and CBS/CPBS operations, by conducting QA reviews on new workflows implemented within the departments.
- 3. Identifies, recommends and implements proactive and innovative solutions to problems by researching other institutions. Explores opportunities for optimizing system including seeking assistance from third party vendors.
- 4. Responds to all requests for QA analysis from all areas including Senior Administration requests. Coordinates, prioritizes and sets timelines for these requests with various QA team members. Ensures all QA projects are staffed, completed and reported upon in a timely fashion. Supports team on QA initiatives and workflow audits on a regular basis. Formulates and organizes a team necessary to complete the required workflow/account review.
- 5. Provides project management expertise and supports team members to make sound decisions. Establishes group goals and provides group with the training and tools required to perform functions effectively. Assists team in the development, implementation and maintenance of automated and integrated methodologies for data collection, retrieval presentation, analysis and interpretation. Ensures the quality and integrity of data collected for decision-making and works with the other areas of the organization to ensure consistent reporting of information. Analyzes and makes recommendations for improved data quality.
- 6. Keeps abreast of receivable and workflow challenges to ensure QA initiatives are implemented as risks are identified. Attends monthly receivable meetings to stay current on receivable trends. Monitors payer and governmental regulations as they pertain to the third party payers to ensure QA analysis is in sync with current guidelines.
- 7. Utilizes knowledge and understanding of CBS/CPBS departmental Policies and Procedures to provide input in the development of new Policies and Procedures as necessary. Supports team by providing expertise in operational and strategic technology decisions from a data warehousing/database perspective.
- 8. Participates in the interview process and selection of QA personnel. Provides input for annual performance appraisals through the matrix management approach. Supports team work and communication among all project participants to foster a work environment conducive to collaboration, brain storming, problem solving, risk mitigation and accountability.
- 9. Performs other related duties and projects as assigned by the Sr. Manager or the Director of Financial Services, CBS or CPBS.
Bachelor's degree required with major course work in Business Administration, Public Administration, Finance, Accounting related discipline. Master's degree preferred. Epic certification required (or obtained within 18 months).
Five (5) to seven (7) years of demonstrated experience in revenue cycle at an advanced level with interaction from both a hospital operations and payer/provider perspective. Experience should involve knowledge of database software. Proven experience with Epic, project planning, writing and process improvement.
Epic certification required (or obtained within 18 months).
Demonstrated ability to work independently and take initiative in areas of responsibility. Able to think at the System level while understanding and integrating CBS/CPBS and delivery network requirements. Epic certification a plus. Excellent analytical, mathematical, organization, prioritization and oral/written communication skills. Demonstrated expert ability to use spreadsheets, word processing, pivot tables, and database management packages. Knowledge of patient accounts receivables, access management and healthcare related issues. Ability to perform detailed analysis quickly and accurately with the ability to convey results in a positive, effective manner. Strong ability to evaluate, prioritize and problem solve a variety and multiplicity of tasks and ensure their timely and accurate completion. Ability to communicate needs and schedules, as well as ensure that plans are in place and standards are adhered to. Strong teamwork and interpersonal skills at all management levels.