PURPOSE OF THIS POSITION

The Self-Pay Analyst and Compliance Specialist is responsible for supporting efficient business office operations at Blanchard Valley Health System through the consistent monitoring of business office processes, as well as identifying and analyzing opportunities for improvement. In addition, this individual plays a key role in business office staff development by evaluating and designing business office procedures, completing government and internal audits, and participating in training and continued education as needed. Further, The Self-Pay Analyst and Compliance Specialist is responsible for staying up to date on industry best practices, informing leadership of potential process improvements, and representing the business office during organization-wide initiatives. 

JOB DUTIES/RESPONSIBILITIES

Duty 1: Develops and follows a standardized process for identifying and launching improvement initiatives. Analyzes staff productivity in addition to reimbursement and audit data to develop plans for process standardization, quality outcomes, and a positive work environment Duty 2: Educates and partners with leadership at all levels to explain operations that would benefit from a new process; recommends improvement plans that contain thoughtful operational transitions away from status quo procedures; and considers how best to train staff and sustain activities within the new process Duty 3: Performs root cause analysis using appropriate tools available in-patient financial services Duty 4: Coordinates initiatives with patient access, HIS, and RI leadership to address efficient patient billing obstacles caused by upstream errors Duty 5: Mentors staff involved in improvement efforts by providing strategies for adhering to project timelines, and reviews initiative results with team members to highlight their impact on Blanchard Valley Health Systems’ overall success Duty 6: Completes internal audits and external audits (Medicare credit balance, HCAP, S10, etc.) Duty 7: Provides feedback on new and existing business office policies and procedures; may provide insight and edits during the proposal, drafting, and review processes Duty 8: Collaborates with Patient Financial services trainer throughout new hire orientation and continuing education efforts to ensure staff is aware of and follows established business office policies and procedures Duty 9: Serves as expert on all business office functions and processes, best practices, federal regulations, compliance standards, and more Duty 10: The above duties reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position. Duty 11: Maintains a thorough understanding and education of federal and state regulations and payer specific policies and requirements to promote compliant credit and collection practices. Adheres to HIPAA related privacy, security and transaction & code set regulations in compliance with the federal guidelines. Accurately documents all account activity. Regularly attends and actively participates in staff meetings, in-service, and continuing education programs as offered. This provides needed educational updates for compliancy and organizational changes in the healthcare industry. Duty 12: Regularly attends and actively participates in staff meetings, training and continuing education that aligns with recognized improvement opportunities, payer policies and procedures and ensures to maintain up to date certifications. This could be remote and/or onsite as requested. Assists in other duties and projects as needed assigned by the supervisor and/or manager.

REQUIRED QUALIFICATIONS

Degree in healthcare administration or related field and/or relevant work experience. Certified Marketplace Counselor completed within 6 months of hire date. Certified Patient Financial Services Specialist certification (CPFSS) within 12 months of hire date. Certified Patient Access Specialist certification within 12 months of hire date. 3-5 years customer service, insurance/patient billing, or related fields experience Excellent written and verbal communication with positive oriented interpersonal skills. Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status.  Must be able to interpret the appropriate information needed to identify each patient’s requirements relative to their age-specific needs and to provide the care needed as described in the area’s policies and procedures.

PREFERRED QUALIFICATIONS

2-3 years financial counseling, eligibility screening, and/or Medicaid application processing Prior experience completing audits, and providing education Medical terminology ICD 10 and/or CPT coding knowledge

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for three hours, walk for one hour and stand for two hours per day. The associate must be able to lift 20 pounds. The individual must have excellent eye/hand coordination to operate the machines. This position requires corrected vision and hearing in the normal range.

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