AddressGENERAL SUMMARY:
The Transaction Flow (TF) Consultant is responsible for leading and supporting teams through the design and implementation of initiatives that focus on people, process, and technology changes. In this role, identification of initiatives will occur through technical analysis and facilitation of multi-disciplinary, team based root cause analysis of edits and denials. TF Consultant should utilize knowledge of Epic optimization to implement identified initiatives and workflow processes. The TF Consultant will be responsible for synthesizing issues at a high-level and preparing recommendations for Leadership.
Develop project plans and perform project management for the design and continuous evaluation of CBO insurance follow up and recovery functions and workflow, to organize work based on production action to achieve optimal efficiency and productivity.
2. Deliver significant business results that utilizes strategic and creative thinking, problem solving, and individual initiatives.
3. Leads and supports the development of new CBO work queue structures based on homogeneity and production action, including development and monitoring of WQ specific productivity metrics, and the development of WQ filtering and other methods to assign work.
4. Perform surveillance of denial, edit, and other data elements to identify trends and opportunities for performance improvement.
5. Coordinate and leads process improvement meetings to implement error prevention efforts. Research best practices for improvement and implement quantitative and qualitative benchmarking.
6. Lead CBO department and cross-functional workgroups to implement initiatives to reduce denials and other errors. This includes coordination with other HFHS business units, Corporate revenue cycle, hospital departments, physician practices, and other teams across the organization.
7. Coordinate and facilitate meetings with insurance payer representatives and internal leaders to develop a more efficient transaction flow and reduce transaction processing issues and administrative burdens. Prepare internal Leadership prior to external meetings.
8. Manage the development of continuous feedback loops and communication with internal customers pertaining to denial and write off improvement opportunities
9 Assists with the development of process performance metrics. Documents current processes and new processes; facilitates design of new processes incorporating process improvement fundamentals (removing waste, hand-offs).
10.Provides expertise using change management tools and methods to ensure successful and sustainable implementation of the transition to a production-oriented CBO recovery function, and process improvements to drive the reduction of denials, edits, and preventable loss write offs.
11.With assistance on assigned projects, drives implementation of critical business metrics & ongoing end-to-end process reviews. This will include the following steps:
a) Identify key processes and their indicators; b) Establish baseline metrics; c) Report through financial and business review process; and, d) Develop and maximize improvement plans.
12.Supports, coaches, and mentors CBO team members and process owners to utilize a defined PDCA process improvement methodology.
13.Communicate effectively in written and verbal formats to various situations and audiences.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's degree in Business Administration, Health Care Administration or related field.
- Master's Degree preferred.
- Minimum of three (3) years of healthcare experience required with progressively increasing areas of responsibility including performance improvement, project management, or staff management.
- Epic, revenue cycle and /or, large healthcare system experience preferred.
