Patient Financial Pre-Services Manager

The Patient Access Pre-services Manager oversees the daily operations of the Patient Access Pre-services Supervisor(s) and their teams, fostering a highly engaged and productive workforce through coaching, guidance, and regular assessments of staffing and productivity needs. This role emphasizes supervision and management of all aspects of the patient access pre-services department, including scheduling, pre-registration, insurance verification, patient estimates, prior authorizations, centralized referrals, and quality improvement initiatives. The manager will collaborate effectively with other managers and stakeholders to ensure timely work products, accurate information, and an efficient pre-service patient experience.

Qualifications

Education/Experience/Skills:

• Bachelor's degree or an equivalent combination of education and four years of experience in a related field.
• A minimum of three years in patient financial services or a related area, including at least one year in a managerial role within healthcare.
• Proven experience in the healthcare revenue cycle.
• Familiarity with revenue cycle functions such as registration, coding, billing, and follow-up.
• Proficiency with IT systems relevant to finance and healthcare revenue cycle.
• Knowledge of Meditech revenue cycle systems is preferred.
• Commitment to maintaining confidentiality regarding patient care and employee information, while upholding HIPAA regulations and professional ethics.
• Exceptional communication skills to engage with patients, physicians, family members, and co-workers, emphasizing a customer service focus and positive language.
• Ability to utilize interpersonal styles and techniques to gain acceptance of ideas and modify behavior as needed to accommodate various tasks and stakeholders.
• Strong leadership qualities and objective analysis skills with a proactive approach to problem-solving.
• Analytical skills to identify issues and opportunities, draw conclusions from diverse data, and develop effective solutions.
• Capacity to thrive in a fast-paced, dynamic environment with adaptability and flexibility.
• Proficient in mentoring and guiding team members effectively.
• Strong computer skills, including proficiency in MS Office and EMR software.
• In-depth understanding of department processes and financial workflows, including scheduling, prior authorization, registration, coding, billing, and follow-up.
• Creative and critical thinking skills to swiftly address atypical issues and challenges.
• Ability to work independently with minimal supervision while making informed decisions within established operational guidelines and policies.

Responsibilities

• Lead recruitment, scheduling, supervision, retention, and performance evaluation of scheduling, centralized referrals, prior authorization, and patient estimates staff.
• Provide mentorship to ensure staff competency in hospital patient financial pre-services processes and progression of skills, aiming for a team engagement score at or above organizational goals.
• Implement a training program specifically on relevant hospital regulations and best practices to ensure compliance and efficiency in tasks related to pre-service patient account management.
• Foster an engaged and knowledgeable pre-services team by holding regular meetings to review hospital relevant processes, changes in regulations, and operational updates.
• Conduct performance appraisals with a focus on information accuracy and an efficient patient experience, ensuring that employees meet or exceed established performance benchmarks for timely work products.
• Prepare and present relevant training materials to enhance organizational performance.
• Promote effective teamwork within the patient financial pre-services teams and with other revenue cycle and clinical staff.
• Facilitate regular cross-department training sessions to ensure that all team members understand the revenue cycle, resulting in improved accuracy in upstream and downstream processes and a reduction in service delays, billing errors, and denials.
• Assess and allocate workload appropriately to ensure high-quality work and meet performance standards.
• Set and monitor KPIs for accuracy and cycle times, targeting authorization submission accuracy and an average turnaround time from authorization submission.
• Regularly review performance data to proactively address any declines in productivity or performance.
• Communicate updates regarding departmental processes and payer requirements promptly to the team to ensure compliance with hospital policies and timely workflows.
• Maintain a system for tracking changes in payer policies and ensure that all relevant team members are informed within 24 hours, minimizing claim denials and delays in payments.
• Identify and act on opportunities to enhance partnerships with insurance providers and internal departments such as other revenue cycle, clinical and administrative areas.
• Work towards a goal of decreasing disputes with payers by fostering open lines of communication and establishing regular check-ins with key insurance contacts.
• Ensure compliance with federal, state, and hospital regulations to maintain a secure and effective working environment.
• Aim for a 100% compliance rate during audits by conducting regular training sessions on HIPAA, insurance regulations, and hospital information security practices for all staff.
• Leverage all the hospital's revenue cycle management software to streamline operations and improve efficiency.
• Optimize the use of analytics to monitor backlogs and track key performance indicators, leading to decreased service delays and improved cycle times.
• Apply rigorous problem-solving principles to enhance hospital pre-service processes, with a focus on minimizing authorization denials and enhancing revenue realization.
• Set a goal of reducing the overall authorization denials and delays through targeted intervention strategies.
• Assist in developing and managing the Patient Access Pre-services department’s budget to ensure that operations remain cost-effective and in line with financial targets.
• Monitor expenses with a goal of staying under budgeted figures, identifying and recommending cost-saving measures related to operations without compromising service quality.
• Implement strategies to achieve financial objectives while maximizing staff efficiency.
• Set targets for improved throughput and reduced backlogs in all service lines.
• Generate detailed reports on key metrics, such as scheduling lag times, percentage of claims denied for no authorization, and average initial authorization submission to approval time, patient estimate compliance, etc.
• Develop actionable plans based on these metrics to enhance revenue cycle operations and monitor the effectiveness of implemented strategies regularly.
• Collaborate with stakeholders, including hospital administrators, clinical staff, revenue cycle teams, and IT teams, to enhance processes and integrate new technologies.
• Aim to successfully implement system upgrades or new software tools each year that improve accuracy in workflows and enhance overall revenue cycle efficiency, with measurable tracking of positive outcomes post-implementation.

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned.   This position reports to the Director of the Revenue Cycle. 

HIPAA:  This position will have access to the Protected Health Information described below, in order to carry out the duties related to the position at Hays Medical Center, based on the following criteria:

• Primary – required (routine) to do the job;
• Secondary – required for the job, but mostly by exception; and
• None – no approved access

Description of Information:

• • Primary
    • Financial Information/Insurance (information related to insurance, billing, and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates
    • Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion
    • Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical
  • Secondary
    • Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes

Infection Control: This position will include initial and ongoing training in dealing with infection control. Training could include, but is not limited to, blood-borne pathogens, bodily fluids, and biohazardous materials, as it applies to your daily work environment.

Patient Interaction: Occasionally