Quality Analyst, Revenue Cycle & Financial Verification

Essential Functions

• Providing feedback to both Revenue Cycle and Financial Verification leadership teams to support quality and performance standards
• Review and audit patient charts in Epic to ensure compliance with financial verification policies and procedures
• Verifying insurance coverage, gathering copay/coinsurance/deductible information, and identifying areas of improvement in workflows
• Validate insurance coverage and ensure accurate documentation of copay, coinsurance, and deductible information
• Identify discrepancies in insurance verification processes and provide actionable feedback to leadership and Financial Verification Specialists
• Review and audit patient charts in Epic to ensure compliance with revenue cycle policies and procedures
• Analyzing revenue trends and performance to identify improvement areas
• Regularly audit patient accounts to ensure accurate billing practices
• Identifying and resolving issues that may result in delayed or denied claims
• Conduct detailed evaluations using departmental quality monitoring forms for audits
• Prepare and deliver performance feedback and audit outcomes to employees and supervisors in a clear and constructive manner
• Track and analyze quality performance metrics; provide regular reports to the Quality Manager
• Develop and update process documentation, guidelines, and training materials related to revenue cycle and financial verification and chart auditing
• Collaborate with supervisors and team members to identify root causes of errors and recommend process improvements
• Assist leadership and learning & organizational development in the optimization of training programs to enhance the skills and accuracy of Financial Verification Specialists and all Revenue Cycle Specialist positions
• Support initiatives to ensure compliance with organizational policies, payer requirements, and regulatory standards
• Serve as a subject matter expert in financial verification and revenue cycle processes and EHR functionalities
• Demonstrate a commitment to patient-centered care, racial equity, and organizational values. Promote use of new or improved technology. Identify improvement opportunities and functions requiring change. Develop clear recommendations consistent with best practice process to remediate identified quality issues
• Collaborate within the appropriate stakeholders to identify performance improvement opportunities
• Escalate identified opportunities, issues, and out-of-benchmark metrics to the Quality Manager of internal operations for additional investigation and action plan development
• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
• Provides positive and development feedback and accountability related to practices including, but not limited to, equity
The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.

Qualifications and Experience (Required)

• Bachelor’s degree, in a Health Care Management or Health Care Administration or a related field or 4 years equivalent experience in quality/auditing in lieu of education requirement, preferably in revenue cycle quality
• Minimum of 2 years' experience in revenue cycle management, including financial verification
• Experience in health care operations or centralized scheduling
• Proficiency in Epic EHR system
• Excellent problem-solving service skills
• Experience with coaching and performance improvement approaches
• Ability to facilitate group discussions
• Proficiency with Microsoft software (Word, Excel, etc.)
• Demonstrated ability to maintain a customer-centric service approach
• Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN, if necessary
• Strong attention to detail and follow-up; and ability to multi-task
• Demonstrated dedication to Planned Parenthood’s mission, vision, and values
• Strong interpersonal skills and the ability to build relationships

Qualifications and Experience (Preferred)

• 3+ years of relevant experience in quality assurance, analysis, or improvement
• Certification in Medical Coding, Billing, or Health Information Management (e.g., CPC, CCS, RHIT).
• Experience with centralized revenue cycle and financial verification processes
• Familiarity with regulatory and payer requirements for insurance verification
• Strong statistical and analytical and problem-solving abilities

Key Requirements

• Commitment to advancing race(+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices
• Understanding of the impact of identity dynamics on organizational culture
• Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards