Overview
In this module, you learned about the significance of staffing in healthcare strategic planning initiatives 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 Production
Claims Submission
Determining Expected Reimbursement
Adjudication
Benefits Statements
Claims Reconciliation
Denial Management
In this assignment, you will create an analysis report on the staffing system of a healthcare organization based on the
identified areas of the back-end process of the revenue cycle.
This assignment will help you describe best practices for revenue-cycle staffing models and align staffing models with
strategic planning initiatives. It will also enable you to demonstrate how key leadership competencies improve revenue-cycle
team performance. From a healthcare management perspective, this activity will help you understand how to set up and
manage a robust staffing process. This activity will help you prepare for subsections 2C (Staffing Impact) and 4B (Workflow
Assessment Findings) in the course project.
Directions
Create an analysis report on the staffing requirements in the backend process of a healthcare organization.
If you need writing support, access the Online Writing 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 questions 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 questons to guide your response:
How does each area incorporate operatonal 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 questions
to guide your response:
What skillsets or knowledge should a leader look for when recruiting somebody for the back-end process?
How would the leader keep the team updated in skillsets and knowledge?
4. Lapses and Prevention: Identify processes to prevent lapses and/or gaps in the staffing model. Consider the following
questions to guide your response:
What kind of lapses and/or gaps are possible across the ensure 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 Production and Claims Submission areas of the
revenue cycle. Consider the following questions 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 initially declined claims and delayed payments to
healthcare organizations. Consider the following questions to guide your response:
Do healthcare organizations 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 citations 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 section of the course for additional support.
What to Submit
Submit your analysis report as a 5- to 6-page Microsoft 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
Staffing
Competencies
Exceeds proficiency
in an exceptionally
clear and insightful
manner, using
industry-specific
language
Describes the
staffing
competencies
needed for hiring
team members in
the back-end
revenue cycle
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
10
Revenue Integrity Exceeds proficiency
in an exceptionally
clear and insightful
manner, using
industry-specific
language
Explains the
importance of each
area of the revenue
cycle for preserving
revenue integrity
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
10
Role of
Leadership
Exceeds proficiency
in an exceptionally
clear and insightful
manner, using
industry-specific
language
Explains the role of
leadership in
ensuring staffing
competencies
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
10
Lapses and
Prevention
Exceeds proficiency
in an exceptionally
clear and insightful
manner, using
industry-specific
language
Identifies processes
to prevent lapses
and/or gaps in the
staffing model
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
15
Impact of Failure Exceeds proficiency Discusses the Shows progress Does not attempt 15
Module Five Project Preparation Rubric
in an exceptionally
clear and insightful
manner, using
industry-specific
language
impact of any
failure in the Claims
Production and
Claims Submission
areas of the
revenue cycle
toward proficiency,
but with errors or
omissions
criterion
Financial Impact
of Declined
Claims
Exceeds proficiency
in an exceptionally
clear and insightful
manner, using
industry-specific
language
Discusses the
financial impact of
initially declined
claims and delayed
payments to
healthcare
organizations
Shows progress
toward proficiency,
but with errors or
omissions
Does not attempt
criterion
15
Articulation of
Response
Exceeds proficiency
in an exceptionally
clear and insightful
manner
Clearly conveys
meaning with
correct grammar,
sentence structure,
and spelling,
demonstrating an
understanding of
audience and
purpose
Shows progress
toward proficiency,
but with errors in
grammar, sentence
structure, and
spelling, negatively
impacting
readability
Submission has
critical errors in
grammar, sentence
structure, and
spelling, preventing
understanding of
ideas
10
Scholarly and
Professional
Sources
Incorporates more
than three
scholarly, current
(within the last five
years) sources, or
use of sources is
exceptionally
insightful
Incorporates three
scholarly, current
(within the last five
years) sources that
support claims
Incorporates fewer
than three
scholarly, current
(within the last five
years) sources, or
not all sources
support claims
Does not
incorporate sources
10
APA Style Formats in-text
citations and
reference list
according to APA
style with no errors
Formats in-text
citations and
reference list
according to APA
style with fewer
than five errors
Formats in-text
citations and
reference list
according to APA
style with five or
more errors
Does not format intext citations and
reference list
according to APA
style
5
Total: 100%
