Manager Patient Financial

Position Summary

The Manager of Patient Financial Services is responsible for developing initiatives to improve third party and insurance account follow up, denials management and resolution of account issues. In addition, the Manager develops cost effective processes to increase efficiency, and acts as a point of contact for various outsourced vendors.

These duties and responsibilities described below represent the general tasks performed on a daily basis. Any other duties as needed to drive to the vision fulfill the mission and abide by the values of the organization.

Essential Duties and Responsibilities

• Manage the activities of employees and vendors to ensure adherence to CRMC standards

• Monitor and track staff productivity and quality to collect cash and resolve Accounts Receivables

• Provide continued education to staff with regards to healthcare reform, payer updates, and system upgrades

• Work collaboratively with the Senior AR Systems Manager and Director to meet departmental goals and objectives

• Works with other Revenue Cycle Departments, such as Care Management, the CFO, HIM, Finance, Patient Access, or others within Revenue Cycle

• Assist Senior and Executive Management in the successful development and execution of CRMC strategies to support CRMC's mission and goals

• Manage all aspects of insurance account follow up for approximately 40,000 accounts for $200 million in accounts receivable

• Review, monitor, and validate staff or vendor-initiated adjustments for certain dollar thresholds

• Collaborate with the Director of Patient Financial Services to assign goals for the Insurance Follow-up and Denials management

• Monitor levels of productivity for each specific individual through productivity, quality, and AR aging reports

• Review of ATB and Work Ques Management, adjusting and conducting Quality Reviews to optimize operations and workflows, for maximizing revenue and adjustments

• Month End Reporting to capture and consolidate issues and trends recording for Finance

• Monitor daily volumes and statistics for incoming phone calls, website usage and system notes

• Monitor and maintain strict compliance with Medicare and Medicaid Quarterly Credit Balance Reporting

• Prioritize all work for the Follow-up and Denial areas to meet the goals as assigned via the Leadership systems and in other IT systems

• Always strive for excellence in the resolution of all claims and ensure that all regulations are followed for compliance

• Attends as an expert witness for Bad Debt and Court Cases (affidavits) in legal instances

• Liaison for current Vendors, EPIC, and systems operations

• Exercise quality judgment in handling of patient questions or complaints, physician requests/contacts, and internal interaction with other hospital departments or vendors

• Resolve patient complaints, vendor relations, charging issues, and interdepartmental concerns in a timely and professional manner

• Incorporate all new programs and procedures into the routine of the department, and keep the employees and stakeholders aware of all changes

• Oversee the training and orientation of all new employees and vendors within the department

• Prepare daily, weekly, and monthly reports that track the progress of the department's follow up, denials and customer service

• Understand and use the department computer systems in an effective and proficient manner

• Actively participate in service recovery and customer service activities to ensure a superior customer contact

• Adhere to CRMC's confidentiality policy for all information related to patients, family and friends, hospital employees, physicians, and clients

• Maintain effective interdepartmental communication

• Conduct employee interviews/employment recommendations

• Maintain employee scheduling/general staffing

• Complete time and attendance records/payroll discrepancies

• Conduct and monitor employee annual performance evaluation/in-service/competency testing/disciplinary action

• Complete other duties as assigned by the Director of Patient Financial Services or CFO

• Consistently demonstrate excellent techniques in work performance through quality assurance reviews

• Demonstrate knowledge of contract terms for insurance carriers and vendors

• Stay current with insurance program changes and offer suggestions to ensure the efficient running of the department

• Attend required departmental and hospital-wide orientations, meetings, and in-services

• Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care

Reporting Relationships

Reports to: Director, Patient Financial Services — may also be assigned work from the Chief Financial Officer (CFO)

Supervises: An estimated 20 employees, including team leads, patient account representatives, senior patient account representatives, customer service representatives, and credit balance representatives

Responsibilities: Manage the daily activity of Insurance Account follow-up, denials, and customer service

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

Minimum Required Education:
Bachelors Degree in Business, Healthcare Administration, or related field

Preferred Education:
Master’s Degree and professional certifications

Experience

• 5+ years in an acute care setting with extensive background in billing and follow up

• This position is responsible for revenue cycle operations specifically for Home Health and Hospice services. Candidates must have prior experience in Home Health/Hospice billing, collections, and payer relations

Licensure/Certification

Applicant must be licensed to work as a Certified Revenue Cycle Specialist (CRCS) at time of hire; if registry eligible, licensure must be obtained within 1 year of start date.