Quality Assurance Specialist Full Time Days

Employment Type:
Full timeShift:
Day Shift

Description:
The Quality Assurance Specialist is responsible for conducting needs assessments within Patient Access to ensure quality assurance and Trinity Health and SAHS Standards are met. Duties include creating training materials such as job aids; scheduling of training sessions and facilities; and measuring and reporting outcomes. The position is responsible for staff audits of SAHS Patient Access and SAHS Pre-Service, to ensure outcomes and activities are in order to maintain data integrity and compliance. This role will identify trends and report the outcomes and activities in order to ensure data integrity and compliance of process guidelines and effectiveness of the training team.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• Must possess a demonstrated knowledge of quality assurance and training operations, as normally obtained through a Bachelor's degree in Healthcare or Business Administration, Education, Organizational Development, Human Resource Development, Finance or Accounting or a related field, or an equivalent combination of years of education and experience.
• Prefer at least 2 years of Patient Access and Patient Accounting experience. Certification within adult education preferred.

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Organizational Mission, Core Values, and Vision in behaviors, practices, policies and decisions.
• Must be able to set and organize own work priorities, and adapt to them as they change frequently.
• Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
• Must possess teaching skills that enhances user learning and involvement. Ability to convey complicated information to end-users in a concise, user-friendly manner that ensures user competency and process compliance, while energizing users' discussion and input.
• Must be able to perform audit functions in a concise, timely and professional manner to include: data retrieval and review; error identification and correction; documentation and display of data in a concise, understandable format; identification of trends; and recommendation of process/system improvements.
• Must be able to demonstrate creative coaching and counseling skills when dealing with education and development issues.
• Excellent problem solving skills are essential as decisions and judgment utilized by the incumbent impact on the overall operations and work flow of the hospital and Medical Staff.
• Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.
• Must be able to travel to the various Trinity Health sites (20% +) as needed.
• Must possess the ability to comply with Organizational Health policies and procedures.
• Demonstrates a broad base knowledge in education, business, information technology, training/instructional design, organizational change and experience in implementing strategic projects/ initiatives. Fluency in Microsoft Office, Excel, Word, PowerPoint, Visio, etc.
• Demonstrated ability to interpret 3rd party payer contract requirements and recommend, design and implement procedures for compliance with regulations and standards.
• Ability to communicate and work with physicians, physician office personnel, associates, case managers, 3rd party payer review personnel, and others in order to expedite the revenue cycle processes to avoid negative financial impact on the facility. Dynamic communication skills (verbal and written), conflict management and strong facilitation and consensus building skills in dealing with trainees, associates, and internal/external customers.
• Ability to interact frequently with staff at the Home Office and Ministry Organizations, and with external parties, such as financial auditors, 3rd party payer auditors, consultants, and various hospital associations.
• Demonstrates the ability to be a collaborator - a team player and a capable influencer and motivator; to think creatively and conceptualize innovative solutions to business problems. Demonstrates the ability to be a change agent/leader, coach, and mentor - to secure buy-in, break-down barriers and secure sponsorship.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health and Saint Alphonsus.
• Supports and aligns with the Region's Training/Education process, by providing training and educational opportunities in revenue cycle systems (e.g., HealthQuest, Receivables Workstation, Claims Administrator, online Eligibility/Verification software, etc.), policies/procedures/guidelines (EMTALA, HIPAA, etc.) and processes.
• Develops and aligns County rules and regulations with the Benefit Advocacy colleagues. Researches and defines the language of the Idaho County requirements and develops on going training to support this function.
• Conducts needs assessment to include methods of interviews, questionnaires, review of competency tests, group problems analysis, examination of existing records and reports. Needs may be determined by researching data entry accuracy/productivity reports, task analysis and communications received from associates/management.
• Documents annual quality assurance/training strategy and plan (competency requirements, expected outcomes, target audience, budget, and facility/equipment requirements).
• Assists in the development learning objectives, priorities, structure, activities, instructional media, materials and methods of instruction most appropriate for the particular group/individual and at the appropriate skill level (novice, advanced, remedial).
• Schedules facilities, equipment and participants; produces publicity/marketing of the educational activity to the intended audience.
• Conducts the instructional event through lecture and demonstration-based instruction, adjusting instruction methods to meet associate needs. Works in coordination with Ministry Organization Leadership and assigned Data Integrity Specialist.
• Reports and monitors the impact that learning has had upon the individual(s) and whether or not a change in behaviors/actions has occurred, through associate interviews, session feedback, QA/QI audits and other documentation. Determines the strengths/weaknesses of the program, making adjustments to ensure improvements.
• Provides feedback to participants as requested during the training session, as well as feedback to management of the participant's competency.
• Ensures that departmental associates have maintained annual educational guidelines (TB, Risk Management, Lifting Techniques, CPR and etc.).
• Maintains program records, including course completion, participants' competency testing results, and certifications and related reference materials.
• Provides written updates and communications, user forums and other available tools and methods.
• Communicates regularly and works with revenue cycle and clinical associates, service line leadership, and others in order to expedite the charge capture, registration/intake, and billing/follow-up processes to avoid negative financial impact on the facility. Provides education to physician and physician office personnel in regards to reimbursement guidelines, as required.
• In coordination with Patient Access and Patient Accounting Regional Directors, monitors and coordinates responses to the latest regulatory billing/payment requirements of the federal, state and 3rd party payers to ensure Trinity Health facilities are in compliance and that electronic data processing (EDP) systems and system mapping/coding structures are maintained to minimize manual processing and maximize claims acceptance and reimbursement. Translates regulatory requirements into daily operational procedures.
• Coordinates and publishes periodic briefings directed to Patient Access and Patient Accounting Directors/Managers regarding changes in legislation, computer systems and other data pertinent to revenue cycle operations and planning.
• Supports the Region's Quality/Audit process, in coordination with the Ministry Organization's Leadership, assigned Data Integrity Specialist, and department's management team. Establishes monitoring tools and oversees data collection and analysis, communicating data to appropriate areas in a timely, effective manner. Procedures will include the analysis of data screens, edit reports (DNFB, denial follow-up, pre-bill edits, etc.), source documents, batch proofs, and custom reports, as well as the interpretation of audit data, display of errors, statistical trend analysis, presentation of data to users, and/or recommendation of potential process/system changes. Utilizes outcomes in the development of future educational programs and/or system/process redesign and to enhance user compliance.
• Provides user support to facilitate health services delivery/patient care by responding to user inquiries in a timely, effective manner, analyzing issue(s) and formulate plans to address each, coordinating efforts with others as required. Identifies common trends and prepares/delivers system tips to end users.
• May prepare special reports as directed by the Manager to document performance and training outcomes. Reports will be statistically sound, displaying content in easily understandable format.
• May serve as relief support, if the work schedule or workload demands assistance to departmental personnel. Cross training in various functions is expected to assist in the smooth delivery of departmental services.
• Other duties as needed and assigned by the Director/Manager.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, the Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health.

Visit www.saintalphonsus.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Alphonsus Health System.

Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.