Centralized Pre-Service/Authorization Patient Access Manager

Overview

Directs and coordinates the activities of patient registration within MH, including offsite locations. Manages and coordinates operations of department patient registrars' quality review and improvement process. Oversees the department's compliance initiative(s) and coordinates these efforts with MH affiliate(s). Provides appropriate revenue information and commentary, affecting financial reimbursement; Provides admissions function interface within the hospital and identifies admissions trends. Enforces departmental policies, practices, procedures and work rules in accordance with approved department and hospital policies and assists in the development and implementation of new policies according to hospital guidelines. Responsible for the monitoring of daily activity and completion of performance and metric reports, such as financial clearance reports. May perform special projects and reporting when assigned. Acts as part of the management team to ensure that the group is meeting all operational goals. Reviews and corrects registration issues on a daily basis.

Qualifications

Education:

Bachelor's degree in business administration, public administration, health care administration, accounting, or a related field required. Will also consider an Associate degree and active enrollment in a Bachelor's degree program with completion of Bachelor's degree within 2 years from hire date into position.

Experience:

• Minimum three (3) years in a management position is required.

• Three to five (3-5) years of Patient Access Services/ Patient Financial Services or related experience preferred.

• Preference given to candidates with knowledge of Cerner applications/models, thorough knowledge of all aspects of personnel management, including patient collections, knowledge of regulatory requirements, scheduling, pre-registration/registration, insurance verification, pre-authorization, billing and reimbursement, medical necessity, customer service, and service recovery.

Other Knowledge/Skills/Abilities:

• Knowledge/experience in point of service and post service collections, with ability to manage/negotiate difficult collections.

• Ability to plan, direct and supervise all aspects of patient registration activities. Should possess leadership as well as technical skills, with strong emphasis on revenue cycle and front-line customer service.

• Ability to build effective teams and motivate others, creating strong morale and enthusiasm.

• Ability to establish and maintain effective peer relationships

• Ability to manage and supervise the work of others, directly and through subordinate supervisors; appraise performance; counsel and train employees; recommend and implement disciplinary actions as necessary.

• Excellent oral and written communications skills, with ability to develop and implement effective policies and procedures, and to collect, interpret and evaluate narrative and statistical data pertaining to fiscal management; Prepare complex reports, memoranda and other written materials.

• Ability to establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, contractors and other health care industry personnel.

• Demonstrated problem solving skills and ability to exercise sound judgment and initiative in very stressful situations required. Ability to effectively manage competing priorities and work independently in a rapidly changing environment is essential.

Responsibilities

• Plans, assigns, trains, directs, and monitors the work of subordinate staff, including subordinate supervisors; develops and/or approves staff schedules; analyzes and distributes staff assignments and workloads; evaluates employee performance; recommends and implements employee disciplinary actions as appropriate; initiates and coordinates staff selection and training processes; ensures that staff activities comply with organizational expectations.

• Reviews, prepares, and completes action plans for implementing production, productivity, quality, and customer-service standards; identifies and resolves insurance billing/patient balance issues compliantly per state and federal regulations, MH rules and guidelines, and best practice standards; completes audits; determines needed system improvements and leads in implementing change.

• Maximizes revenues by providing information pertinent to administrative deliberations on short and long-range patient-pay and third-party reimbursement issues, recommending options, and implementing revenue-generating programs. Develops and monitors financial reports for areas of responsibility. Researches best practices and measures performance against internal and external industry standards for the collection and management of accounts.

• Achieves admissions operational objectives by contributing information and analysis to functional strategic plans. Develops financial metrics and monitors staff performance toward assigned financial targets monthly. Provides ongoing training to facilitate understanding of revenue cycle processes, including point of service collections.

• Ensures the consistent management, application, and communication of Memorial's Financial Assistance Policy per IRS 501 (r) regulations, to applicable patients or other interested parties.

• Performs cost impact analysis, trending, benchmark variances, and other organizational analyses to determine the effects of pre, point, and post service collection activities; presents the results to management to clarify findings and gain consensus; monitors the effectiveness of department controls associated with collections practices and proposes integration and/or changes, as needs dictate.

• Enhances patient care delivery system by providing admissions function interface with the nursing and professional staff; coordinating admissions functions with various inpatient and outpatient care units; working within designed bed placement, financial reimbursement, Information Services, and other supporting systems.

• Serves and protects the hospital community by ensuring adherence to professional standards, hospital policies and procedures, federal, state, and local requirements, and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Oversees and ensures the integrity, security, and confidentiality of information obtained through patient accounts and financial records

• Maintains professional and technical knowledge by attending educational workshops and conferences; reviewing professional publications; establishing personal networks; participating in professional societies.

• Assists various departments in the education and training of staff regarding patient registration.

• Develops, recommends and implements policies and procedures for assigned programs and services to

• Ensures consistency with hospital standards and requirements; directs the development and maintenance of appropriate procedure manuals and related documents

• Maintains visibility and rounds on staff monthly

• Responds to concerns and/or complaints from patients, the public, medical staff, subordinates, and/or other hospital employees pertaining to assigned areas; researches and investigates issues; prepares written or oral responses as needed

• Represents assigned areas to other hospital divisions, other County departments, and external agencies to coordinate activities, identify issues, resolve problems and share information; confers with hospital administrative, clinical and other personnel to resolve management and patient access issues; participates in organizational and departmental strategic planning activities to ensure the delivery comprehensive and coordinated health services; serves on committees and task forces to address specific issues and/or represent the department as assigned; attends meetings and conferences as assigned.

• Develops/maintains process and performance metrics for assigned call center operations, including developing and revising procedures relating to how customer inquiries are answered, monitored, tracked, and resolved. Develops call center metrics for measuring performance standards such as call time, wait time, abandonment rate, and peak call periods per defined standards.

• Serves as educational resource and subject matter expert in knowledge of hospital, department and Joint Commission policies and procedures related to Patient Access

• Develops plans and creates applicable timelines for creation and implementation of new learning opportunities for staff. Determines human, facilities, budgetary and equipment resource requirements, schedules activities and ensures that all classes/learning offerings are appropriately documented, planned, controlled, communicated and executed.

• Administers assigned budgets; monitors, evaluates and approves expenditures within limits of authority; analyzes staffing needs; performs cost/benefit analyses as appropriate; plans and estimates future costs including capital expenditures as appropriate; justifies requests for equipment and personnel.

• Develops and distributes a variety of statistical summaries and reports related to average throughput time, unit and individual performance, and adherence to regulatory requirements. Monitors for trends and initiates corrective action as required.

• Manages external suppliers' performance in terms of cost, service, quality, and overall effectiveness. As needed, institutes corrective action and ensures synergy between the organization and the vendor to provide seamless process and service

• Reviews and resolves any verification issues associated with third party health insurers, liability insurers, and workers compensation insurers.

• Performs other related work as required or requested.