The Quality Coordinator, Admitting (PFS) is responsible for a wide range of duties in support of departmental efficiencies which may include but are not limited to performing financial clearance, performing thorough analysis discharge not final billed (DNFB) reports, duplicate encounter reports, Past Due Arrivals Reports, and other Revenue Cycle Reports and all other duties assigned by Patient Access Leadership.

Essential Duties:

• Responsible for Reviewing and reconciling encounters on the DNFB/EBEW reports. Resolving the issues daily focusing on reducing the Patient Access DNFB.
• Responsible for working the Past Due Encounters with charges daily in Identifying if activation of the encounter is appropriate or escalating the encounter to the hospital charge auditor for review.
• Responsible for reviewing and auditing claims for coding accuracy, benefits payment and compliance through a thorough understanding of requirements for financially clearing patients for transfer and or admission, and ability to interpret and comprehend insurance benefits and division of responsibility (DOFFR) for all types of payors.
• Plan and conduct audits of medical claims against established criteria based on all types of payor: HMO, PPO, Medicare, Medi-Cal, Research and Workers Compensation.
• Responsible for daily quality assurance review of staff registrations: • Ensuring appropriate plan code usage, all elements required to ensure clean claim submission that supports Revenue Cycle Goals and initiatives. • Analyze audit results to determine root cause of errors and recommend process improvements. • Review error trends to identify training opportunities. • May provide education on regulatory compliance and proper claims documentation methods.
• Performs other duties as assigned.

Required Qualifications:

• Req High school or equivalent

• Req 4 years Experience in related field with emphasis in Medical Insurance and hospital registration

• Req Advanced proficiency with Microsoft Office applications and competent keyboarding.
• Req Excellent organizational skills, oriented detail-oriented a strong ability to multi-task.
• Req Customer Service skills including problem resolution and patient satisfaction.
• Req Ability to maintain confidential information.
• Pref Familiarity with medical terminology.
• Req Must have strong understanding of insurance and authorizations

Preferred Qualifications:

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)