Job Description

Job Description

1. Develop and implement training guidelines and resources.

• Ongoing training and education of staff.
• Perform successful new employee orientations.
• Design, implement and communicate process and guideline changes.
• Implement new protocols to assure staff understanding.
• Assists all team members questions efficiently and effectively.
• Perform monthly educational in-service to staff regarding changes and updates.
• Implementing and maintaining monthly quality reviews to ensure accuracy.

2. Executes a comprehensive review of all cases meeting criteria, coordinates and performs patient / customer interview to define needs, develops and implements a strategy to enable the patient / customer to meet their financial obligation to Shenandoah Medical Center in a mutually satisfactory manner.

• Advocates for patients and family members and acts as a liaison with insurance companies and other third parties to assist in obtaining insurance and other financial information to secure financial approval for services.
• Confirms payer sources with close attention to coordination of benefits, identifies which contract / plan will provide payment for planned care.

Performs detailed financial screening of benefits.

• Determines benefit coverage to ensure that it meets the standards and explains the financial requirements to the patient or responsible party and arranges / collects appropriate payments per financial screening policy.
• Develops accurate point of service collections communication and facilitates the collection of these payments.

3. Maintains current knowledge of rules and regulations of industry and government programs, hospital financial and billing policies and educates patients, families, team members and other staff as necessary.

• Maintains extended knowledge base of payer and billing requirements for federal, state, local and commercial sources.
• Maintains and expands knowledge base of web based applications used for determining eligibility.
• Participates in educational programs and in-service meetings to build upon current knowledge base.
• Maintains current, extended knowledge of hospital financial and billing policies.
• Acts as an educational resource for patients, families, the community and the hospital staff.

4. Acts as an advocate of behalf of patients and families to enable patients / families to take full advantage of services which may be available to them.

• Assists in locating resources and / or assistance programs for which uninsured / underinsured patients may be eligible.
• Informs patients and clinical teams of anticipated gaps and or lack of insurance coverage.
• Interviews patients and or family members in person advises patient with regard to next steps or process for securing financial coverage.
• Assists patients and or family members in completing applications to applying for resources with external agencies or hospital financial assistance in an accurate and timely manner.
• Continues to serve as a point of contact for patients / families throughout the completion of processes.
• Keeps Manager apprised of exceptions, high grade complaints and issues in a timely manner.

5. Manage and Performs Financial Clearance

• Verifies eligibility and benefits for each patient.
• Obtains prior authorization / pre-certification as required by payer.
• Creates patient financial estimate as required.
• Presents and completes patient waivers as required.
• Documents all financial clearance notes, authorization numbers, and patient correspondence.
• Scans into the EHR system all necessary financial clearance documents.
• Works with work ques in SFM and Trac as required.

6. Respond to requests in a timely manner to allow for accurate and efficient flow of problem solving.

• Identify issues as they arise.
• Contact outside vendors or suppliers to provide or obtain information and resolve issues.
• Communicate progress and resolution to staff.
• Maintains a high level of confidentiality referencing verbal and written communication. Shares information only with those who have a need to know.

7. Manages and performs employee relations functions effectively to promote a positive work environment, influence retention and enhance communication.

• Ensures effectiveness in the application of employee relations within their areas of accountability.
• Develops, supports, and actively seeks activities and establishes an environment that promotes recognition and retention for employees.
• Communicates effectively and provides feedback to staff which may include participation in department meetings, individual employee meetings, rounding, etc.
• Addresses employee issues in an effective and timely manner.
• Recognize, take action and report deficiencies in a timely manner.
• Refers to policies and procedures with employees, as necessary.
• Completes annual performance appraisal process for staff.

8. Maintains and demonstrates working knowledge to carry out policy and procedure to effectively comply with departmental, organizational, regulatory, and agency needs.

• Utilizes knowledge and critical thinking to equitably apply policy and procedure to all patients and customers.
• Promotes secure environment for the procurement of patient’s protected health information (PHI).
• Complies with regulatory requirement such as OSHA, JCAHO, and HIPAA.

9. Provides exceptional customer service support.

• Ensures outstanding public relations.
• Ensures that contacts are positively enhanced by serving as a resource for patients, families of patients and hospital management and staff.
• Provides accurate information to all customers by phone or other communication media.
• Answers telephone calls and related questions in a professional manner and with patience and maturity.
• Communicates effectively with department contacts, patients and management to thoroughly investigate and resolve issues.
• Works with positive attitude and shows commitment to co-workers and organization.

10. Supports Chief Financial Officer

• Other duties as assigned.
• Works closely with the Chief Financial Officer on special projects.
• Lead Financial Counseling team.
• Development and communication of protocols.
1 day ago