Quality Assurance Trainer - PAVE

Luminis Health

Title: Quality Assurance Trainer, Pre-Authorization Verification & Eligibility (PAVE)

Department: PAVE 

Reports To:  Director - PAVE

Cost Center/Job Code:  10000-50130-001786

FLSA Status:  Exempt

Position Objective:

The Quality Assurance Trainer is the teacher, resource, and change agent for the PAVE department. Working with the staff and management of the registration, financial counselors and ancillary areas the Quality Assurance Trainer is responsible for the assessment, planning, development, implementation, evaluation and maintenance of staff educational needs. Serves as a role model for all levels of staff. Formulates teaching plans for direct staff and participates in the department quality improvement plan by reviewing accounts and providing feedback to staff concerning their quality of work and productivity levels. Supports and participates in identification and application of appropriate research, in-service, annual competencies, and changes in policies & procedures. The Quality Assurance Trainer advises the Management team of all significant performance issues and recommends discipline when appropriate. To safeguard assets of the hospital by remaining vigilant over changes in the health care industry and monitoring activities of the department to implement changes quickly and efficiently. Assist with account completion to ensure process workflows are current with technology.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Design and maintain new hire PAVE training materials. Conduct new hire registration training biweekly. Evaluates and supports new hires for a minimum of six months. Works with department leaders to develop Performance Improvement Plans, when necessary.

Using Epic scorecard functionality, reviews quality of accounts insurance and authorization for all PAVE staff, identifying areas of opportunity for re-training, new education, or workflow re-design. Identifies and develops competencies for staff, holding in-service training sessions as needed Reports on issues with registration performance to department leaders.

Identifies denial trends that may be positively impacted by registration education and implements training.

Responsible for understanding the complexities of health insurance plans and the relationship between health plans (Medicare, Medicaid, Commercial Insurance, Blue Cross, Worker’s Compensation, MVA coverages, and self-pay.

Assists with the completion of accounts by obtaining authorizations, verification of insurance eligibility and benefits.

Develop competency assessments for all PAVE training and are responsible for conducting/overseeing training, post-class assessments, record keeping and communication of end-user completion of training.

Respond to training issues or needs when identified by end-users and leadership. PAVE training may be virtual, classroom based and/or unit/department based, and includes one-on-one training, remedial training, and on-call training support to assist end-users.

Performs quality assurance testing and work queue monitoring to assist in developing training needs as well as shadowing all PAVE positions.

Responsible for the creation and standardization of educational materials.

Performs other duties as assigned by PAVE Leadership.

Educational/Experience Requirements:

• Minimum five (5+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
• Knowledge of registration, verification, pre-certification, and scheduling procedures.
• Experience with Medical and Insurance terminology (ICD-10, CPT 4)
• Minimum of three (3+) year of demonstrated strong analytical skills
• Proficiency with Microsoft Office and Outlook required
• Excellent verbal and written communication skills.
• Preferred experience with the Epic Hospital Billing System

• Associates Degree Accounting, Finance, Business Administration or Healthcare related field; required. Bachelor’s degree, preferred   
• Minimum seven (7+) years of Revenue Cycle Experience in lieu of degree
  

Required License/Certifications:

• One (1+) or more certifications from AAHAM, NAHAM or HFMA preferred or obtained within 6 months.

• Healthcare Certification 
• 1 or more Certifications preferred:
• CRCE - Certified Revenue Cycle Executive
• CRCP- Certified Revenue Cycle Professional
• CRCS- Certified Revenue Cycle Specialist
• CHAM – Certified Healthcare Access Manager
• CHAA- Certified Healthcare Access Associate
• CHFP- Certified Healthcare Financial Professional
• CRCR- Certified Revenue Cycle Representative

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.