Data Quality Analyst

The Data Quality Analyst, a key position in the Revenue Cycle, manages all data quality projects as assigned by the PFS Manager and PFS Assistant Manager. Researches and reports detailed findings based on criteria given by the PFS Assistant Manager and PFS Manager. Has an overall understanding of all OPA & PFS functions in order to identify and assist in resolution in problem prone areas. Additional responsibilities include resolving all hospital and physician credit balances. Cross trained to assist with Piedmont charge process, submission of the Quarterly HCIA Inpatient claim data and the Quarterly Medicare Credit Balance report. Provides feedback on suspected issues or areas of concern to the PFS Supervisor and/or PFS Manager.

JOB RESPONSIBILITIES

Project management

• Completes all projects accurately and within allotted timeframe.

• Clarifies details of all projects to ensure an understanding of desired outcome of project. 

• Maintains a calendar of deadlines for all projects

• Notifies PFS supervisor of any delays or roadblocks encountered with projects.

• Assists as needed in collecting and communicating orders for Piedmont surgeries to Piedmont staff and assists with reconciling and balancing all Piedmont surgery and ancillary charges in an accurate and timely manner, maintaining appropriate spreadsheets.

• Posts charge corrections accurately and in a timely manner.

• Accurately documents account history with details of any action taken.

• Notes variances in a timely and accurate manner.

• Serves as a resource to PFS Supervisor to assist as backup for vacancies, PDO and backlogs in all PFS areas.

• Performs account audit based on agreed upon parameters

• Assists with special projects as needed

• Assists with system testing and training under direction of the PFS Manager

Credit/Refund Analysis

• Completes review of all insurance and self-pay credit balances accurately and within a timely manner

• Requests appropriate refunds based on SC guidelines accurately and in a timely manner

• Provides supporting documentation for all requests exceeding specified limits

• Notifies PFS management of all identified trends in received Refund Requests within a timely manner

• Notifies PFS management of any high dollar Refund Request within a timely manner.

Reporting

• Develops/runs appropriate queries to target data to be reviewed.

• Assists as needed to complete HCIA Quarterly Inpatient survey in a timely manner.

• Assists with maintenance of Daily spreadsheets (Key Indicators & Daily AR Balancing) in a timely and accurate manner.

• Provides tracking and reporting all charge entry errors to the PFS Supervisor.

• Provide data and support to management from on-going projects and in identification of any issues, including inhouse, discharged but unbilled, insurance, and authorization delays.

• Provide accurate compliance reporting data, reporting through system queries as needed.

• Identifies and reports all repeat discrepancies found as part of routine duties.

Other

• Keeps abreast of all PFS billing, follow up and refund processes and procedures to ensure all processes are compliant per federal guidelines. 

• Maintains knowledge of all industry changes and incorporates those into process after PFS supervisor approval.

• Keeps abreast of and is able to interpret all Shepherd Center contracts accurately.  Aware of resources available for assistance as needed.

                                                                                                                       

REQUIRED MINIMUM EDUCATION

• College degree preferred or equivalent work experience.

REQUIRED MINIMUM CERTIFICATION

• N/A

REQUIRED LICENSURE

• N/A

REQUIRED MINIMUM EXPERIENCE

• Previous Patient Financial Services experience knowledge in multiple areas, including refund, credit balance, authorization and denials related reporting.

• 5 - 7 years’ Patient Financial Services experience in multiple PFS practices.

• Experience working with medical payers including Medicare, Medicaid, and commercial insurance, Workers Compensation.

• Working knowledge of financial systems.

• Excellent organizational skills, and

• Proficiency in Microsoft Office Suite

REQUIRED MINIMUM SKILLS

• Knowledge of all aspects of Revenue Cycle practices required.

• Must be proficient in Excel and A/R software.

• Strong keyboard skills.

• Organizational skills to manage multiple ongoing projects.

• Works well in environment and self-discipline with firm deadlines; results oriented.

• Perform multiple tasks effectively.

• Able to work both independently and as part of a team.

• Strong analytical skills required.

• Capable of making timely, independent decisions.

PREFERRED QUALIFICATIONS

• N/A

PHYSICAL DEMANDS

• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time or exerting up to 15 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

WORKING CONDITIONS

• Normal Hospital Office Environment.