Program Manager Quality Assurance, Cash Operations
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Under direction of the Manager, Cash Operations, the Program Manager of Quality Assurance will be responsible for the development and maintenance of the quality program for the Cash Operations department. This includes the initial and ongoing training of Accounts Receivable Specialists within Revenue Cycle Operations. This role also involves maintaining the quality program by which the Accounts Receivable follow-up work will be evaluated for opportunities and enhancement. Ultimately, the QAC provides and supports the infrastructure necessary to ensure that the training and performance improvement needs of the Cash Operations Specialists are met.
Overall quality program ownership and management with a focus on:
• Initial development along with ongoing evaluation and maintenance of a quality program including scoring measurements and rebuttal process.
• Perform routine audits of accounts worked by Cash Operations Specialists to assess diligence and urgency, and report findings to Cash Ops Leadership.
• Effectively communicate audit results to individual Cash Operation Specialists and provide necessary coaching and re-training.
• Conduct quarterly competency assessments for Cash Operation Specialist.
• Assist and support Team Leads and Cash Operation Managers with performance improvement initiatives.
Lead and direct the AR Department New Hire Training sessions and department competency standards including:
• Responsible for training Cash Operation Specialists on athenaNet and other relevant applications and systems related to third party claims billing and follow-up.
• Training responsibilities will also include applicable Steward Medical Group policies and procedures and Cash Operations workflows.
• Identify and initiate additional training needs or enhancements, in partnership with Cash Ops Management.
• Maintain professional competency, according to department policies, procedures and protocols.
• Maintain a repository of knowledge required to train new revenue cycle associates including manuals, tip sheets and other materials.
• Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations.
REQUIRED KNOWLEDGE & SKILLS:
• 3 years minimum experience in physician billing and AR follow-up, within a highly productive environment.
• Demonstrated ability to effectively train others in a work environment.
• Experience with patient accounting systems, billing/claim submission software required. AthenaNet experience required.
• Knowledge and understanding of industry best practices, relative to billing and claims follow-up procedures.
• Ability to analyze claims worked and assess the level of quality based on defined performance standards.
• Possess ability to work efficiently and accurately, and to organize and plan work.
• Possess flexibility and adaptability to work additional hours and to work under stress.
• Ability to establish and maintain effective working relationships and communicate clearly with customers both within and outside of Steward.
• Highly detail oriented and well organized; ability to multitask.
I. Education: Associate’s or Bachelor’s Degree preferred, or commensurate years of experience.
II. Experience (Type & Length): At least 3 years’ related experience, 5 years if no degree.
III. Software/Hardware: AthenaNet required (certification a plus), MS Office suite required.
Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.
Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and mask policy is required for patient and colleague safety.