Quality Analyst, Revenue Cycle & Financial Verification

Quality Analyst, Revenue Cycle & Financial Verification

The vision of Clinical Health Network for Transformation (CHN) is to better fulfill the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.

CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health and race equity in our organization.

The Revenue Cycle (RC) & Financial Verification (FV) Quality Analyst is responsible for improving operations by monitoring key performance indicators (KPIs) and providing the information gathered for employee feedback and interventions across all functions within the Clinical Health Network for Transformation (CHN). The RC & FV Quality Analyst is responsible for reviewing patient charts in both Epic and NextGen electronic health records (EHR) systems to ensure the accuracy and completeness of both the financial verification and revenue cycle processes. This position requires expertise in chart auditing, audit outcomes dialogue, insurance verification, revenue cycle, and EHR systems (Epic and / or NextGen). The RC & FV Quality Analyst reports to the Quality Manager and collaborates with other team members to uphold organizational standards and enhance patient experience.

Responsibilities also include identifying and reporting trends and concerns regarding quality assurance metrics, including statistical reporting documentation. Ideal candidates for this position are engaging and customer focused.

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

Qualifications and Experience (Required)

Qualifications and Experience (Preferred)

Key Requirements

$20.77 - $31.15 an hour. CHN believes in fair and equitable pay. Above is the pay range for this role. Please note that actual salaries may vary within the range, based on factors including, but not limited to, education, training, experience, professional achievement, and business need.

CHN provides employees with a competitive benefits package; some highlights include the following :

Clinical Health Network for Transformation (CHN) is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression / identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member / veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including people of color and members of the LGBTQIA+ community.