Provides leadership and oversight for Financial Clearance functions. (Pre-Registration, Coverage Verification, Patient Liability Collection, and Referral Authorization) Supervises, monitors, coaches, and develops employees in applicable functional areas. Ensures that pre-registration accuracy rates are achieved, and financial clearance requirements are consistently met and patients are pre-registered with complete information. Functional areas which report to this position include pre-registration and financial clearance.
PRIMARY DUTIES AND RESPONSIBILITIES:
Oversee day-to-day operations of the Financial Clearance team, ensuring its ability to accurately collect and validate all required data elements for hospital and account creation in Revenue Cycle systems.
Oversees day-to-day operations for all areas of responsibility and ensures the team's ability to obtain and record accurate demographic, financial, and clinical information necessary for the financial clearance of scheduled patient accounts prior to services being provided.
Support management functions including hiring, training, disciplining, performance appraisals, and competency performance standard development.
Support all aspects related to employee time records. Assist in coordination of department staffing and scheduling in line with budget and patient needs.
Manage the team's ability to perform follow-up activities with patients and/or referring physician offices in the event of failed eligibility, lack of authorization/referral or lack of patient benefits for scheduled services.
Confirm employees are accurately performing functions in a manner which are compliant with established processes and quality assurance programs and works with staff to address areas of non-compliance.
Manage the maintenance activities of appropriate records, files, and timely and accurate documentation entry of data in Revenue Cycle systems.
Monitor the team's ability to accurately confirm eligibility of patient coverage benefits, including coverage limits, number of days, patient responsibility, and effective dates.
Support activities to notify patients of their liabilities prior to date of service as determined by insurance benefits and coverage limits and collect liabilities per department guidelines.
Routinely runs QC reports, edits accounts, develops training materials, and serves as a support to the entire department.
Provides support to Revenue Cycle personnel on Access related issues. Daily monitoring and follow up on Access related work lists.
Coaches and mentors' staff regarding Patient Access processes and provides ongoing training.
Monitor and trend denials making recommendations and process changes to reduce appeals and reprocessing and improve cash flow Assess workflow prioritization daily to confirm the departments metrics and benchmarks are consistently achieved.
Assists the team with solving issues as it pertains to authorizations, registration, eligibility, and denials.
Maintain up-to-date knowledge of regulatory and compliance changes impacting area of responsibility and ensure employees are appropriately educated and processes are modified as needed.
Support and assist in department functions/responsibilities as needed based upon volume and workload.
Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization's culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
EDUCATION/EXPERIENCE/TRAINING:
Bachelor's degree preferred or equivalent combination of education and experience.
Two years of experience in Scheduling and/or Financial Clearance functions.
Supervisory experience in healthcare environment preferred.
Experience and knowledge of hospital billing/registration systems. Knowledge of Epic preferred
Experience and knowledge of regulatory requirements, payer requirements and third-party reimbursement.
Excellent communication and interpersonal skills.
Ability to evaluate personal performance against established goals.
Ability to coach and support staff in their efforts to improve overall performance.
Ability to communicate with a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.
Capable of learning reporting systems and other new tools.