Franciscan Missionaries of Our Lady Health System

Analyst

• Analysis and Recommendations
• Provides on-going trend analysis to identify reasons for denials and apply corrective actions steps to prevent cash flow retardation.
• Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Responsible for facilitating the internal appeal process.
• Actively works through denied claims and attempts to gather information and take appropriate action to ensure claim is adjudicated properly.
• Quality
• Promotes the quality and efficiency of his/her own performance through participation in staff educational programs, approved continuing education courses, and specialized skill training programs.
• Utilizes all equipment, supplies, facilities, and resources in a prudent and efficient manner in order to ensure efficient departmental operations and the provision of high-quality health care services.
• Other Duties as Assigned
• Performs other duties as assigned or requested.

Denial Analyst, RN

Affiliate Manager

• Coordination of Care
• Reviews evidenced based care measures for population of patients, assists providers with quality measures to ensure the care needs are outlined and established prior to visit optimizing patients time with the Provider.
• Prepares for clinic interdisciplinary team meetings/huddles by confirm previous orders have been completed and resulted, review inpatient admissions, review anticipated annual screenings, prepare agenda for meetings, print patient care summary for providers as needed, identify high risk patients and communicate with team for follow up.
• Call and schedule patients listed on Quality Gap report and meet specified deadline.**Request results from outside facilities and scan results into patient EMR by established deadlines.
• Observes and adheres to quality standards established by the department. Participates in continuous quality improvement programs in order to foster the provision of quality health care services by the department and clinic to ensure all services are provided with compassion, understanding, and respect for others.
• Conduct post visit review on clinic wellness patients as well as specific measures with Population (Adult and Pediatric) such as uncontrolled blood pressure, etc.
• Performs other duties as assigned or requested.

Clinical Care Partner, MA

• Facilitates Epic vision development, solution design, standards guidance, project scoping, IS strategy integration and implementation of efficient, high quality technology and applications systems.
• Evaluates technology, systems and application capabilities, analyzes workflow/data flow, and creates efficient and logical solutions. Plans, schedules, reviews, and performs analysis, design, construction, testing, and implementation of Epic and related application systems. Participates in solution testing and documents clear and concise system descriptions that meet project requirements and departmental quality standards.
• Utilizes organizational project management methodology, processes, and systems to ensure effective and efficient project development and completion. Evaluates requests for programming and provides timetables for completion.
• Collaborates with FMOLHS Information Services, leaders, team members and end users to develop efficient, cost-conscious technology and applications system specifications that maximize organizational performance.
• Ensures security, integrity, and privacy of FMOLHS data in conjunction with FMOLHS policies and procedures.
• Develops and implements data driven performance improvement methodologies. Maintains accurate records for use in evaluating organizational performance. Identifies ways of improving current services and consults with management on issues and problems.
• Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.
• Utilizes IS project management methodology and best practices to improve individual and organizational efficiency, effectiveness, and outcomes.

Denial Analyst, RN

Clinical Care Partner, MA

EPIC Application Analyst