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2238375-62865000Certified Healthcare Access Manager (CHAM)Exam Content OutlineI. Pre-Arrival (25%)A. Patient and Family ExperienceDeliver quality service and customer satisfaction Analyze patient satisfaction surveys (e.g., Press Ganey, Gallup, etc)Employ service recovery measuresB. Admission and Transfer ServicesManage intra- and inter-facility referrals/transfersComply with contractual, legal, and regulatory requirementsC. SchedulingAssess customer expectations and special needs of the patient (e.g., age specific, interpretive service, and physical, cultural and emotional needs) Arrange and schedule location, equipment, and/or staff (resources) and document pertinent schedule informationIdentify information required to confirm service for a specific date and time Inform patients of clinical prerequisites: Comply with requirements based on physician orders, protocols, and/or medical necessity D. Pre-RegistrationMaintain integrity of enterprise master patient index (EMPI): Create patient account Validate/initiate medical record to ensure identification and safetyPerform financial clearance:Identify accurate payer Validate and meet payer requirements Inform and/or collect customer financial obligations prior to service Adhere to regulatory compliance standards (e.g., federal, state, and local) Perform financial clearance (e.g., financial counseling, ensure payer authorization is obtained)Verify benefitsII. Arrival (35%)A. Patient Check-in, Admission, RegistrationAdminister patient registration processes:Validate or obtain demographic, admission source, clinical, and financial information (e.g., patient identification validation)Provide and explain patient registration forms (e.g., The Patient Bill of Rights and Responsibilities, HIPAA) Execute consents, signatures, and other required documentsComprehend medical terminology and codingValidate ordered levels of care (e.g., inpatient, observation, and outpatient, status changes) Verify payer plan coverage (e.g., governmental payers, workers compensation, and insurance)Determine coordination of benefitsPerform point of service collectionProvide financial counselingB. Patient and Family Experience Utilize services to help reduce patient and family stress and increase customer satisfaction Facilitate internal and external way finding (e.g., transportation, parking, and drop-off and signage) Identify relevant information to provide to patient and family (room number, visiting hours, etc.) Manage patient directory exclusions Employ service recovery measures (e.g., validating parking and free meal tickets)C. Revenue CycleCapture data elements necessary for accurate billing Strategically align with case management, utilization review, clinical documentation, health information management (HIM)/medical records, billing, follow-up, cash posting, and accounts receivable Mitigate denials management Collaborate with managed care department (e.g., communicate payer issues)D. Information SystemsManage timely input of data Understand impact of patient management system transactions (e.g., electronic data interface, electronic medical records and ancillary systems) Educate on system down time and recovery III. Access Management (40%)A. Statistical ReportingDetermine benchmark processes to improve outcomesFacilitate process improvementMonitor trending areas of interest (e.g., payment, patient flow, and denials) Develop, review, and refine key performance indicators (KPIs), best practices and dashboardsTrack productivity B. Patient Experience and ManagementProtect patient confidentiality Measure customer satisfaction Anticipate and manage customer expectations C. Professional Development and CompetencyDevelop and measure performance standards Oversee quality metricsD. Leadership and Management Collaborate with human resource managementEstablish effective communication Drive strategic planning Adhere to regulations for complianceParticipate in disaster preparednessManage financial performance (e.g., forecasting, budget)Maximize employee engagement Embrace change management ................
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