Supervisor, Ambulatory Patient Access

DHR Health - US:TX:Edinburg - Days

Summary:

FLSA STATUS: Exempt Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

Under the direction of Ambulatory Patient Access Director, Supervisor will provide the necessary support and leadership for Insurance Verification and Authorizations. As a supervisor this person is responsible for promoting the interest of Doctors Hospital at Renaissance as a whole and conduct all business activities within the framework of Doctors Hospital at Renaissance principles and policies. This Supervisor is delegated the responsibility and accountability for administrative and operations of the Ambulatory Patient Access Department.

POSITION EDUCATION/QUALIFICATIONS:

• High school diploma/GED required
• Understand insurance benefits and medical terminology
• Knowledge of Microsoft Office suite, working knowledge of Excel required
• Experience in health related fields is necessary.
• Previous healthcare experience (1-2) years is required, hospital experience preferred.
• Excellent customer service skills.
• Good written and verbal communication skills required.
• High degree of competency/experience in general.
• Communicates clearly and concisely and is able to work effectively with others employees, patients and external parties.
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Medical Terminology, ICD-9, ICD-10 Codes, CPT Codes, HCPCS codes, Modifier knowledge preferred.
• Able to perform mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Requires working with frequent interruptions.
Must project a professional image.

Responsibilities:

POSITION RESPONSIBILITIES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Appropriately monitor and verifies benefits for all accounts on the daily basis
• Reviews and confirms patient’s financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage.
• Assists with the training of new personnel.
• Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier and on patients account
• Interviews, evaluates, trains, supervises and counsels employees as needed.
• Meets with Manager/Director regularly to effectively communicate and resolve issues, set and prioritize goals and improve process.
• Ability to identify the appropriate coordination of benefits for insurance carrier.
• Utilizes phone or on-line verification systems, i.e. TMHP, Availity, & Relay Clearance for insurance eligibility and benefits.
• Determines financial status and refers patient for financial screening as appropriate.
• Ensures referral/pre-authorization/pre-certification requirements have been met.
• Obtains pre-certification approval as needed
• Obtains date of injury, compensable bodily injury, adjuster’s name, onset of illness and claim number, for worker’s compensation claims.
• Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure.
• Prepare short registration by obtaining patient demographic information, type of insurance, diagnosis and procedure requested as needed.
• Recommends changes in department policies and procedures to Manager/Director.
• Enter appropriate mnemonic in the notes tab in patient accounting system.
• Monitors employee timesheets on a daily basis to avoid any overtime.
• Assists in approving PTO’s for employees.
• Communicates information about scheduled case procedure to various departments and personnel involved.
• Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Document clearly and concisely all patient benefit information on accounts through the patient accounting system (Pre-cert screen, account notes section of Paragon and ORM schedule).
• Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required.
• Maintains a contact list for each physician office.
• Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
• Have a diligent and effective communication when directing staff.
• Manage staff to meet day to day operational requirements.
• Review staff's quality and quantity of work, report and trend.
• Other duties as assigned.

Other information:

LINES OF REPSONSIBILITIES:

1. Director of Ambulatory Patient Access 2. VP Revenue Cycle Professional 3. Chief Ambulatory Officer

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable ____________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________

Transfer/Hire Date Effective: ________________________.