Financial QA/Training Specialist - Denial & Appeals Mgmt

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only designated Level 1 Trauma Center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Active - Benefit Eligible and Accrues Time Off

Responsible to review, research, and analyze accounts for quality. Provides comprehensive education and training to the PFS staff including multiple system applications. Will perform data quality review, statistical reporting and follow-up training and education as required. Implements and updates comprehensive training material when necessary. Assist with testing new programs and processes and coordinates and develops training plans for new software or hardware implementations. Work collaboratively with the PFS Supervisor and Manager to achieve department and quality, satisfaction, and financial goals. Responsible for adhering to all Federal regulations and maintaining current knowledge of all Insurance guidelines.

• Uses knowledge of patient accounting and registration to complete quality nonclinical reviews and to identify any areas of non-compliance with established quality and performance goals and standards.
• Develop and administer the orientation and training curriculum to new or tenured PFS staff on related systems and processes. Administers and signs-off on employee competency level at the completion of training.
• Documents and reports weekly all QA findings to PFS Supervisor. Minimum of 50 encounters must be reviewed per week. Trends findings for use in staff education.
• Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives.
• Promotes and maintains working relationships within a multi-skilled environment to facilitate department/hospital vision, mission, and goals.
• Acts as an expert resource to all PFS areas for questions related to systems, processes, regulations, policies, Standard operating procedures, etc. Attends and participates in Staff Meetings.
• Stays abreast of changes, government and nongovernment, guidelines and insurance/managed care plans. Seeks seminars and online training pertinent for position and necessary to enrich job performance and department training/education
• Perform any other responsibilities as assigned by immediate supervisor.

Essential:

• Demonstrate knowledge of word processing, spreadsheets and data base applications needed to carry out functions of the role.
• Demonstrates effective interpersonal skills, strong written and verbal communication skills.
• A working knowledge of Word, Excel or other Microsoft applications.
• Excellent patient account analytical skills for problem solving, typing of 40 WPM, data entry, and telephone etiquette.
• Demonstrated knowledge of hospital Revenue cycle process and the roles that PFS plays in that process.

Essential:

• Associate Degree

Essential:

• Business/Health Care Management

• Will consider candidate with 5 years’ experience in a patient accounting/patient management field in lieu of a degree.

Other information:
Experience Essential: Five to eight years of experience in the healthcare financial field in patient accounting and experience in knowledge of patient management areas.

Salary : $20 - $25