Description
Job Summary:
MedStar Health has an opportunity for a Quality Assurance Auditor to join our team at MedStar Georgetown University Hospital. The Quality Assurance Auditor's performance of essential functions sets benchmark standards for both the PUBS Customer Service Division and the PUBS Financial Verification Division and provides centralized quality control by performing widespread sampling of all transaction types processed by the 2 units. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's philosophy, policies, procedures and standards.
Primary Duties:
Establishes and manages quality assurance project plans, resources, goals & schedules to support senior level administration initiatives.
Specifically, monitors employees' productivity and quality of work on a regular basis; Audits are aimed at oversight of system edits & making certain to verify proper fsc selection and timely resolution of various types of alerts focusing on ensuring accuracy & timeliness of actions taken on GE/IDX & SMS (eCommerce, TES, GE Claim edits, GE Visit Management Alerts, Website Inquiries, Rapid Response call line, PCS Session Details & On-Base & Collection Status reports).
Attends management meetings and communicates issues/resolutions for process improvements to Director & Supervisors and other staff as needed Develops appropriate reporting tools and trends areas of improvement for distribution to appropriate departmental administrators; Discusses the findings of the audits, explain errors, provides specific retraining and proposes suggestions for future success.
Assists in creating and maintaining comprehensive Policy and Procedure manuals for the Pre-Registration & Customer Service Units; includes ensuring that all changes and business operational updates are discussed with superiors and communicated to the staff.
Works with multiple healthcare systems, interfaces and various reports that are generated for managerial decision-making purposes.
Works closely with Georgetown departmental staff at all Point of Service (POS) locations to ensure that GPG and GUH revenue cycle policies and procedures are followed daily.
Assists in preparation of the delinquent accounts as they are electronically transferred to the collection agency; to include a 2-day process of compiling a work file of all collection agency delinquent candidates and deceased patient accounts and working with the Self Pay Supervisor to reconcile the totals to ensure accuracy in the dollar values and accounts transferred.
Ensures that operational efficiency and managerial cost-effectiveness occurs regularly.
Ensures staff's compliance with the Physicians Unified Billing Services (PUBS) group and the hospital's Central Business Office Billing and Collections Policies and Procedures.
Keeps current with changes in healthcare systems, insurance industry and issues specific to the Appointment Scheduling and Registration initiatives in effect at Georgetown University Hospital and the Georgetown Physicians Group.
Provides support and assists clinical departments with questions regarding Pre-registration Unit's tasks.
Performs other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all inclusive.
Qualifications:
Associate's degree required; bachelor's degree preferred.
3-4 years' experience in healthcare revenue cycle environment with experience in patient access, registration, billing, cash collections, insurance and/or precertification required.
2-3 years supervisory of team lead experience in a hospital setting required.
CHAA – Certified Healthcare Access Associate preferred
CHAM – Certified Healthcare Access Manager preferred
Knowledge of medical terminology and insurance terminology required; must possess a working knowledge of Windows Office applications (Word, Excel, Power Point, Visio, etc.)
Knowledge of the GE/IDX, SMS/Invision, MedConnect/FirstNet and/or other automated registration system preferred.
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