Overview
In this module, you learned about the significance of staffing in healthcare strategic planning ini"a"ves and the revenue cycle.
You also looked at the role of leadership to improve team performance and the areas in the back-end revenue cycle.
To recap, the components in the back-end revenue cycle include (but are not limited to) the following areas:
Claims Produc"on
Claims Submission
Determining Expected Reimbursement
Adjudica"on
Benefits Statements
Claims Reconcilia"on
Denial Management
In this assignment, you will create an analysis report on the staffing system of a healthcare organiza"on based on the
iden"fied areas of the back-end process of the revenue cycle.
This assignment will help you describe best prac"ces for revenue-cycle staffing models and align staffing models with
strategic planning ini"a"ves. It will also enable you to demonstrate how key leadership competencies improve revenue-cycle
team performance. From a healthcare management perspec"ve, this ac"vity will help you understand how to set up and
manage a robust staffing process. This ac"vity will help you prepare for subsec"ons 2C (Staffing Impact) and 4B (Workflow
Assessment Findings) in the course project.
Direc!ons
Create an analysis report on the staffing requirements in the backend process of a healthcare organiza"on.
If you need wri"ng support, access the Online Wri"ng Center through the Academic Support module of your course.
Specifically, you must address the following rubric criteria:
1. Staffing Competencies: Describe the staffing competencies needed for hiring team members in the back-end revenue
cycle. Consider the following ques"ons to guide your response:
What competencies are needed for each area of the revenue cycle?
What makes this competency specific to the healthcare domain?
2. Revenue Integrity: Explain the importance of each area of the revenue cycle for preserving revenue integrity.
Consider the following ques"ons to guide your response:
How does each area incorporate opera"onal efficiency?
How is compliance adherence built into each area?
3. Role of Leadership: Explain the role of leadership in ensuring staffing competencies. Consider the following ques"ons
to guide your response:
What skillsets or knowledge should a leader look for when recrui"ng somebody for the back-end process?
How would the leader keep the team updated in skillsets and knowledge?
4. Lapses and Preven!on: Iden"fy processes to prevent lapses and/or gaps in the staffing model. Consider the following
ques"ons to guide your response:
What kind of lapses and/or gaps are possible across the en"re process?
What are the possible reasons behind these lapses and/or gaps?
5. Impact of Failure: Discuss the impact of any failure in the Claims Produc"on and Claims Submission areas of the
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revenue cycle. Consider the following ques"ons to guide your response:
What are some of the possible events of failure that could happen in the first two areas?
Who would be impacted by such events?
6. Financial Impact of Declined Claims: Discuss the financial impact of ini"ally declined claims and delayed payments to
healthcare organiza"ons. Consider the following ques"ons to guide your response:
Do healthcare organiza"ons face the same financial impact for governmental and private insurance claims?
What steps can be taken by the backend process staff and by leadership to ensure these delays do not
happen?
All the claims in your deliverable should be evidence based. Your cita"ons should be from your independent search for
evidence (not from the textbook, or module resources) of credible sources and be current within the last five years. You are
required to cite between 3-5 resources, with a minimum of three sources, at least one which is not also one of your Project
One resources. Refer to the IHP 630 Library Guide located in the Start Here sec"on of the course for addi"onal support.
What to Submit
Submit your analysis report as a 5- to 6-page Microso$ Word document with double spacing, 12-point Times New Roman
font, and one-inch margins. Sources should be cited according to APA style.
Criteria Exemplary (100%) Proficient (90%)Needs
Improvement (70%)Not Evident (0%) Value
StaffingCompetencies
Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
Describes thestaffingcompetenciesneeded for hiringteam members inthe back-endrevenue cycle
Shows progresstoward proficiency,but with errors oromissions
Does not a&emptcriterion
10
Revenue Integrity Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
Explains theimportance of eacharea of the revenuecycle for preservingrevenue integrity
Shows progresstoward proficiency,but with errors oromissions
Does not a&emptcriterion
10
Role ofLeadership
Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
Explains the role ofleadership inensuring staffingcompetencies
Shows progresstoward proficiency,but with errors oromissions
Does not a&emptcriterion
10
Lapses andPreven!on
Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
Iden"fies processesto prevent lapsesand/or gaps in thestaffing model
Shows progresstoward proficiency,but with errors oromissions
Does not a&emptcriterion
15
Impact of Failure Exceeds proficiency Discusses the Shows progress Does not a&empt 15
Module Five Project Prepara!on Rubric
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in an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
impact of anyfailure in the ClaimsProduc"on andClaims Submissionareas of therevenue cycle
toward proficiency,but with errors oromissions
criterion
Financial Impactof Declined
Claims
Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner, usingindustry-specificlanguage
Discusses thefinancial impact ofini"ally declinedclaims and delayedpayments tohealthcareorganiza"ons
Shows progresstoward proficiency,but with errors oromissions
Does not a&emptcriterion
15
Ar!cula!on ofResponse
Exceeds proficiencyin an excep"onallyclear and insigh%ulmanner
Clearly conveysmeaning withcorrect grammar,sentence structure,and spelling,demonstra"ng anunderstanding ofaudience andpurpose
Shows progresstoward proficiency,but with errors ingrammar, sentencestructure, andspelling, nega"velyimpac"ngreadability
Submission hascri"cal errors ingrammar, sentencestructure, andspelling, preven"ngunderstanding ofideas
10
Scholarly andProfessional
Sources
Incorporates morethan threescholarly, current(within the last fiveyears) sources, oruse of sources isexcep"onallyinsigh%ul
Incorporates threescholarly, current(within the last fiveyears) sources thatsupport claims
Incorporates fewerthan threescholarly, current(within the last fiveyears) sources, ornot all sourcessupport claims
Does notincorporate sources
10
APA Style Formats in-textcita"ons andreference listaccording to APAstyle with no errors
Formats in-textcita"ons andreference listaccording to APAstyle with fewerthan five errors
Formats in-textcita"ons andreference listaccording to APAstyle with five ormore errors
Does not format in-text cita"ons andreference listaccording to APAstyle
5
Total: 100%
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