Summary

Quality Assurance Analysts evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate adjudication of claims. This role requires thorough understanding of regulatory requirements, managed care contract terms, facility-specific internal guidelines, revenue integrity, billing, cash applications, payment variances and adjustment processing including federal and state regulations and guidelines.

Responsibilities

Conduct audits to determine organizational integrity of upstream, midstream and downstream revenue cycle activities that impact the adjustment processing of claims.

Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities and current volumes of adjustments.

Complete special AR projects to help liquidate key segments of Baptist aging AR

Review all timely filing adjustments to determine whether Baptist has exhausted all attempts to appeal and overturn timely filing denials.

Communicate audit results to hospital service departments and departmental leadership, and make recommendations for management corrective action.

Serve as institutional subject matter experts and authoritative resources on interpretation of contract language to ensure appropriate reimbursement by insurance companies.

Performs scheduled and unscheduled independent audits of revenue integrity and business office activities.

Conducts routine retrospective and prospective account audits as directed by revenue cycle system director.

Assess internal and external communication of changes to better communicate across functional departments

Adheres to the defined audit timeline and audit protocol standards; assists with development of the audit schedule; identifies services to be audited.

Annually identifies specific needs for self-development and implements a plan to achieve professional growth.

Applies consistent and standardized compliance audit methodology for sample selection, scoring and benchmarking, development and reporting of findings and repayment calculations.

Prepares written reports of audit findings and recommendations and presents to specific business offices; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records

Participates in the development of the department long-term and short-term goals, objectives plans, policies and procedures.

Requirements, Preferences and Experience

Education

Preferred: Associates Degree related to health care or information technology

Minimum: High school diploma or equivalent

Experience

Minimum: 2 years of experience in the healthcare industry with a working knowledge of hospital or physicians revenue cycle functions.

Training

Preferred: Detailed knowledge of revenue cycle work streams and revenue flow; Revenue cycle process management; Moderate systems expertise; Moderate experience with facility and professional billing requirements

Minimum: Understanding of industry-specific terminology; Managed Care policy manuals and contractual expected reimbursement

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

Competitive salaries

Paid vacation/time off

Continuing education opportunities

Generous retirement plan

Health insurance, including dental and vision

Sick leave

Service awards

Free parking

Short-term disability

Life insurance

Health care and dependent care spending accounts

Education assistance/continuing education

Employee referral program

Job Summary:

Position: 13173 - Analyst-Quality Assurance

Facility: BMH - Central Business Office

Department: HS Denial Mitigation Corporate

Category: Finance and Accounting

Type: Non Clinical

Work Type: Full Time

Work Schedule: Days

Location: US:TN:Memphis

Located in the Memphis metro area REQNUMBER: 20713