Patient Access Outpatient Quality Assurance Team Lead

Overview: The Patient Access Outpatient Quality Assurance Team Lead is responsible for enhancing department operations by overseeing the quality review of assigned patient accounts. This leadership position will guide a team of analysts in performing quality assurance checks on patient accounts, identifying opportunities to decrease insurance denial rates and increase the number of error-free claims processed by the Patient Financial Services Team. The Team Lead will collaborate closely with Patient Access Management and will engage in verbal dialogues regarding the outcomes of audits related to calls, registrations, and other functions within Patient Access.

Reports to: Patient Access Manager

Organizational Expectations:

• Embraces and exemplifies the Jennie Stuart Health and client Mission, Vision, and Values in all actions.
• Represents the organization positively and professionally at all times.
• Fosters a culture of safety for patients and employees through proper identification, reporting, documentation, and prevention practices.
• Upholds hospital standards to ensure a clean and quiet patient environment, enhancing the overall patient care experience.
• Maintains competency in current standards of practice, trends, and developments relevant to the role.
• Complies with infection-control policies, medication administration protocols, and controlled substance regulations.
• Participates in ongoing quality improvement initiatives.
• Ensures compliance with organizational policies, departmental protocols, and applicable professional standards.
• Safeguards confidentiality of patient information in accordance with organizational and regulatory policies.
• Adheres to professional standards, hospital policies, and requirements set forth by federal, state, local, and accrediting bodies.

Essential Functions:

• Lead and mentor a team of Quality Assurance Analysts, providing guidance and support in the quality assurance processes for demographic and insurance information on patient accounts.
• Review and oversee the correction of accounts assigned for pre-determined defects, ensuring high-quality outputs.
• Maintain up-to-date knowledge of insurance requirements, effectively communicating updates to the team through email, memoranda, and training sessions.
• Minimize third-party payer denials by verifying authorization of services and assuring accuracy on assigned accounts.
• Develop a strong understanding of insurance payer basics to quickly identify and correct errors.
• Produce high-quality, high-volume quality reviews and escalate identified opportunities, issues, and out-of-benchmark metrics to the Patient Access leadership team for further investigation and action plan development.
• Collaborate with leadership to implement and monitor corrective action plans based on audit outcomes.
• Perform other duties as assigned to support team objectives and departmental goals.

Nonessential Functions:

• Engage in additional tasks as needed and assigned to support the overall success of the department.

Required Skills

A minimum of 1 years’ experience in healthcare or customer service setting is preferred with a work record that demonstrates:

· Clear, effective communication skills

· Skills in using PC computers and computer applications

· Knowledge of medical terminology

Detail orientation

Required Experience

High school diploma or equivalent required. Previous experience required in one or more of the following roles:

· Customer Service Setting

· Hospital or Medical Office Setting

To perform this job successfully, an individual must demonstrate competence in each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

A minimum of 1 years’ experience in healthcare or customer service setting is preferred with a work record that demonstrates:

· Clear, effective communication skills

· Skills in using PC computers and computer applications

· Knowledge of medical terminology

Detail orientation