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Manager-Patient Financial Clearance

Newark , NJ, USA | Stanford Health Care hospital

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Accounting / Control
    Finance (Internal)
  • Experience:
    5-7 years
Job Description:
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The Manager-Patient Financial Clearance (Insurance Verification & Payor Authorization) is responsible for planning, organizing, leading and directing the overall patient financial clearance functions, which includes pre-registration, payer authorization (outpatient and hospital) and financial counseling functions where applicable, for optimal performance of the front-end patient financial clearance process/revenue cycle.

In addition, the Manager oversees and is accountable for front-end data quality for the pre-registration, payer authorization (outpatient and hospital) and financial counseling activities for Patient Access Services scope of service. Ensures an ongoing procedure for accurate and timely gathering of patient information, securing patient’s insurance coverage limits and benefits and communicating to patients for meeting the financial expectations of the hospital as applicable. Ensures that these functions are performed efficiently throughout the enterprise, which includes maintaining an adequately trained staff to handle all patients in both inpatient and outpatient clinic settings.

The manager must have a clear understanding of multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to maximize reimbursement and minimize financial risk to Stanford Health Care. Successful oversight will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and denials. Interactions will primarily be conducted with both patients and payors and results of efforts will drive actions to secure payment for scheduled and unscheduled patients.Serves as a resource to faculty, managers, and clinic staff in all financial clearance related issues.

Essential Functions

The essential functions listed are typical examples of work performed by positions in this job classification.They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities.Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient’s rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Employee must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions.

Ensures financial clearance functions are performed efficiently throughout the Patient Access services enterprise, which includes maintaining an adequately trained staff to handle all patients in both inpatient and outpatient clinic settings.

Financial Clearance functions include but are not limited to, pre-registration tasks such as, insurance verification, insurance benefits data, regulatory requirements, i.e. Medicare Secondary Payer Questionnaire (MSQP), Advanced Beneficiary Notice (ABN)securing payer authorizations, collecting payments for upcoming services/residual balances to financially secure all applicable accounts.

Provides financial clearance service approach for patients and family from point of contact through charging. Utilizes feedback and needs assessment tools to understand internal customer expectations. Strives to provide services that exceed expectations and works to eliminate barriers to good service. Maintains relations with all internal applicable parties, third party payers, and other agencies, as appropriate.

Maintains a complete record of current policies and procedures followed by staff in the director’s areas of responsibility; responsible for having complete knowledge of the patient flow and steps taken by staff to complete these procedures; assures that staff is adequately trained and meets competency requirements and levels.

Provides effective leadership and manages appropriate staff levels. Develops goals and priorities, and assigns tasks and projects. Develops staff skills and training plans. Counsels, trains and coaches assigned staff. Implements corrective actions and conducts performance evaluations. Provides leadership, direction and guidance. Represents the department on various committees; conducts regular unit staff meetings.

Responsible for designing, developing, and monitoring performance improvement processes such as but not limited to quality, accuracy, productivity and timeliness. Manages implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise. Monitors to ensure that integrity and accuracy of registration data is maintained by the staff supervised. Works collaboratively with other departments to ensure the processes and systems for patient financial clearance processes are standardized and optimized for efficient and effective flow of patients within the department and the organization.

Keeps up-to-date on all regulatory and accrediting agency requirements, including Federal and State regulations and Joint Commission standards as they relate to Registration. Ensures compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed; i.e. Medicare Secondary Payer, authorization for inpatient and outpatient services, and verification of eligibility or other primary coverage. Assures compliance with the medical staff bylaws, rules and regulations, and hospital and departmental policies and procedures.

Identify revenue cycle issues and provide leadership for root cause analysis and problem resolution.

Design and implement appropriate plans to meet goals.

Supports the Director in developing strategies for operational improvement, assists with budget development, and departmental reporting.

Performs other related and incidental duties as needed or assigned.

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. 

Job Qualifications:

Minimum Requirements

Education:Bachelor’s degree from an accredited college or university with a major in accounting, finance, business administration, health care administration, or a related field (or equivalent combination of education/experience) with

Experience: Five (5) years of progressively responsible experience in revenue cycle management (i.e., Pre-Registration, Authorization, Financial Counseling and Billing) in a health care setting.

Knowledge, Skills, and Abilities

These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.

Knowledge of relevant Hospital Policies, Practices and HIPAA regulations.

Knowledge of Registration (Epic) and billing systems (Epic) and databases or other revenue cycle technologies.

Knowledge of Governmental and non-government requirements applicable to patient financial clearance processes.

Knowledge of Current knowledge of third party payer rules and regulations.

Knowledge of ICD-9 and CPT coding.

Knowledge of medical terminology.

Ability to communicate well with patients.

Problem solving abilities, prioritizing, multi-task, meet deadlines and adapt to changing priorities.

Strong organization and decision-making abilities.

Ability to work independently with strong follow-up skills to ensure effective and efficient completion of tasks.

Effective interpersonal skills and professional conduct and ability to maintain effective working relationships with all patients, employees, faculty and upper management.

Ability to facilitate groups.

Demonstrated written and verbal communication skills.

Ability to receive and disseminate information effectively and appropriately, reviewing and acknowledging unit communication.

Ability to apply Lean/project management protocols for efficient workflows.

Ability to manage multiple projects in a timely and efficient manner.

Proficient in Microsoft Excel, Word, Project or other spreadsheet and/or word processing software.

Ability to collect, organize and analyze data to implement appropriate countermeasures.

Ability to provide leadership in problem identification and issue resolution.

Ability to analyze revenue write-off data and identify trends and opportunities and the ability to present such data to a variety of audiences.

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