DenQAIPatient-centered ownership

Role-level diligence

Test the work the future practice actually needs.

Use the same job-related rubric for every person in a role. Record current knowledge, observed execution, judgment, digital fluency, learning, documentation, and backup capability separately. Use observed work and context to identify support needs; leave employment decisions to the responsible people.

Start with evidence: each role starts as not yet reviewed. Record each dimension separately; no employee score or employment recommendation is calculated.

Choose an observation status for each dimension. A missing observation is not a skill deficit. Keep the work sample, date, reviewer, context, and agreed next action in your authorized internal record.

Selected role

Insurance + billing coordinator

Turns documented care into accurate, timely claims and collections while understanding the contract, plan, and patient-billing boundaries.

Role reviewEvidence by dimension

Discuss training, supervision, authority, tools, and backup separately.

Observations stay separate for each role.

Required capabilities

  • Distinguishes carrier, network, plan/product, fee schedule, and patient benefit
  • Submits electronic claims and attachments; monitors acceptance and rejection
  • Uses current licensed coding sources and submits the code that accurately describes the work
  • Works eligibility, authorizations, denials, appeals, aging, credits, recoupments, and refunds
  • Recognizes bundling, downcoding, LEAT, leased networks, noncovered services, and amendment issues
  • Can set up or improve portals, clearinghouse workflows, reports, templates, and task queues

Practical scenarios

  1. A claim was accepted by the clearinghouse but remains unpaid after the payer’s normal window. Show the investigation path and next action.
  2. A new payer offer arrives. Compare its top procedures and identify the contract terms that could change the economics.
  3. A completed, documented service is missing from the ledger. Demonstrate how to identify the correct current billing path without guessing.
  4. A claim is adjudicated under a lower code. Explain coding versus coverage, documentation, appeal, and patient communication.

Evidence to inspect

  • Clean-claim and first-pass payment rate
  • Median denial first-touch and resolution time
  • A/R by owner, last action, next action, and deadline
  • Appeal samples and payer-source citations
  • Credentialing and fee-schedule control log
  • Recent playbook updates and staff teaching examples

Caution signals

  • Relies on office folklore or old code lists
  • Cannot identify the exact plan/product or contracted network
  • Writes off balances without documented reason or authority
  • Queues have no owner, deadline, or escalation
  • Treats AI output as a source rather than a candidate to verify
Turn the evidence into a transition plan.

Record the gap, cause, owner, training or authority change, backup, due date, and observable recheck.

Download 30/60/90 template

Fair process

Observe, verify, and build a transition plan.

Before interviews

Confirm seller permission, confidentiality, timing, role requirements, lawful questions, and who will see results.

Use work samples

Ask for de-identified reports or controlled scenarios. Do not expose patient information or encourage access outside assigned duties.

Document evidence

Separate “knows,” “can demonstrate,” “can troubleshoot,” and “can teach.” Record the source, verification state, missing evidence, and recheck.

Normalize the environment

Distinguish an employee’s skill from missing software, absent authority, bad training, or an owner who kept tasks to themselves.

Offer a learning path

Translate gaps into 30/60/90-day training, supervision, access, templates, competencies, and recheck dates.

Respect employment law

Use counsel for interview and retention design. Never infer capability or retirement from age, disability, family status, or health.