Manager of Pre-Financial Services

Description

Are you a skilled leader with a passion for ensuring seamless patient financial experiences?

Klickitat Valley Health is seeking an experienced Manager of Pre-Financial Services to oversee our financial clearance, preregistration, and prior authorization processes. In this critical role, you will lead a dedicated team to ensure patients are fully prepared for their upcoming services while maintaining compliance with state and federal regulations. If you have a strong background in healthcare financial operations, a commitment to patient-centered service, and a talent for process improvement, we encourage you to apply and be part of our mission to deliver exceptional care to our community.

This position can be on-site or hybrid. 

GENERAL SUMMARY:
The Manager, Pre-Financial Services is responsible for all operations in support of clearing patients for their
upcoming services. This individual is highly skilled and experienced in preregistration, financial clearance, and
prior authorization. This role oversees and leads the team responsible for all facets of pre-registration processes,
financial clearance procedures, and prior authorization operations. The position will stay abreast of the regulations
for Charity Care, Price Transparency, and Good Faith Estimates at the federal and state levels. Create and update
the correlating policies and train and precept staff to ensure they follow them.
The Financial Pre-Services Manager possesses strong leadership qualities, extensive knowledge of healthcare
regulations, and a proven track record of implementing strategies to streamline administrative processes while
maintaining compliance standards.

Qualifications

Minimum Education, Training and  Experience (includes licenses or certifications):

Safety Sensitive per WASB5123: NO

Education:
● Minimum - Associate degree in business, healthcare administration or related field. Two years of
experience in a business or healthcare related field may be considered in lieu of a degree as long as
minimum experience is met.
● Preferred - Bachelor’s degree in business, healthcare administration or related field from accredited
institution.
● Preferred - HFMA/AAHAM certification

Experience:
● Minimum - 3 years of experience working within revenue cycle operations focusing on patient registration,
financial clearance and prior authorization.
● Minimum - 1-2 years of successfully leading a team in revenue cycle operations.
● Preferred - Five (5) years of progressively responsible experience in healthcare or general business
management with competence in the areas of responsibility listed above.

Skills/Knowledge/Abilities:
● Extensive knowledge of pre-registration, financial clearance and prior authorization processes.
● Strong understanding of healthcare regulations including:

• Charity Care requirements
• Price Transparency Laws
• Good Faith Estimates (federal and state-level)
• HIPAA, Medicare and Medicaid Guidelines

● Proven ability to create and update policies in compliance with healthcare regulations
● Expertise in training and mentoring staff to ensure adherence to policies and best practices
● Excellent leadership skills with the ability to inspire, motivate and oversee high-performing teams
● Exceptional communication and interpersonal skills for collaboration and diverse stakeholders, including
insurers, vendors, and clinical teams.
● Analytical skills to monitor key performance indicators (KPIs) and assess departmental performance.
● Proficiency with healthcare revenue cycle management and prior authorization software
● Experience in implementing automation to improve processes and reduce operational costs.
● Requires critical thinking skills; ability to make complicated and essential decisions; analyze complex
data/information, problems, and issues; listen and accept advice from others; demonstrate maturity and
good judgement and work with limited supervision.
● The comprehensive knowledge base in medical account management, including insurance regulation and
practices, understanding EOBs, CPT codes, ICD-9/10 code requirements, compliance regulations, general
management practices, etc.
● Understanding of Critical Access Hospital and Rural Healthcare billing and coding
● Comprehensive knowledge base of governmental regulations related to admission and discharge of
patients, patients rights, HIPAA, Medicare and Medicaid guidelines.
● Ability to develop policies and guidelines, and implement/train staff in understanding insurance account
management processes for handling claims to achieve the financial goals and objectives of KVH.
● Work productively and cohesively within a team and resolve conflict/differences or problems with staff and
other supervisors/managers in a positive, productive manner.
● Promote/deliver excellent customer service to internal (patients and staff) and external customers (vendors,
insurance companies, governmental agencies, and other third parties).
● Must be self-motivated, consistently striving to improve service in all areas of responsibility.
● Work in a stressful/demanding environment and take appropriate action to ensure accurate and high-
quality work is produced and the ability to cope with the jobs physical and emotional demands.
● Maintain a calm and composed manner in emergency/stressful situations, taking appropriate action as
necessary.
● Proven ability to effectively motivate staff and manage performance through evaluations, recognition,
coaching, and discipline.
● Excellent organizational and multi-tasking and time management skills with the ability to anticipate tasks
and prioritize assignments.
● Demonstrates attention to detail and maintains a high degree of accuracy, risk of error could result in
significant monetary loss and/or hardship for KVH.
● Perform sensory requirements such as vision, touch, manual dexterity, fine motor skills, etc, to perform
tasks using computers, computer screens, keyboards, calculators, copiers, faxes, and other office
equipment.
● Experience using everyday computer electronic technology tools (e.g., email, spreadsheets, word
processing, voicemail, internet/intranet) to organize and store work-related data, plus calculator, copier, fax,
etc.
● Proficiency with Microsoft Office Programs, including Excel and Word, is essential, as is excellent
proficiency in the ten key skills. Experience with Meditech software is preferred.
● Professional written and verbal communication skills, effective presentation skills, and the ability to read,
write, speak, and understand English.

GENERAL ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS:

● Mission, Vision, and Values: Organizational vision, mission, values, and strategic goals are clearly
understood and demonstrated. Maintains a positive work and growth environment for all business
office/registration employees by supporting planned change. Uses interpersonal skills to give constructive
feedback/criticism nonjudgmentally, positively, and confidentially.

● Planning and Coordination of Services: The Patient Financial Services Director plans the design and
organizational structure of the patient financial services/registration functions for achieving operational
effectiveness, as well as achieving the goals and objectives set for this department; develops and
maintains operational management action plans, policies and procedures; ensures insurance billing and
collection services of the hospital are planned and managed to meet the financial goals and objectives of
the organization, as well as treating the patient with respect and dignity as a primary focus.

● Operational Management: Establishes and maintains a control system for handling cash, posting/billing
and collecting payment for all patient care services rendered to the patients admitted to KVH; reviews
insurance billing charges and ensures that charges are in compliance with both governmental regulation
and with insurance industry standards; monitors and approves the processes used for managing the
account receivables and collections in coordination with the Chief Financial Officer; provides authorization
for handling bad debt/charity care account write-offs, establishes payment plans for overdue accounts and
the collection arrangements with collection agencies and selects/monitors the use of outside collection
agency services; monitors and ensures that the admission/registration and discharge processes of patients
are consistent with KVH policy and practice, including but not limited to: insurance verification, pre-admit
certification, determination of copay and deductibles established by the patient’s insurance, as well as
governmental regulation/compliance requirements.

● Communication: Maintains an effective communication process with governmental and third-party
insurance organizations to resolve issues that impede cash flow and claims processing efficiency and
would detract from patient/member satisfaction; listens to and attempts to resolve multifaceted concerns of
employees as needed. Written and verbal communications are accurately delivered and received promptly,
clearly, and appropriately. Assist staff with understanding the role of the patient's financial
services/registration in supporting patient care needs.

● Process Improvement: Process Improvement (PI) is provided through services that understand and
attempt to meet patient/customer/employee needs and expectations. Promotes the importance of
responsible billing and collection of patient care services rendered by KVH and the need for minimizing lost
income (bad debt/charity write-offs) due to inefficient handling of insurance claims; implements methods
and practices for improving collection of patient accounts. Participates in the Performance Improvement
(PI) initiatives established through the hospital P.I. plan. Recommends and implements performance
benchmarks and metrics used to measure the performance of the patient financial services/registration
operation.

● Budget Management: Develops department budget; reviews/monitors monthly budget reports for
expenditure appropriateness; analyzes variances from budgets and reports significant issues to the Chief
Financial Officer; makes adjustments or takes corrective action as needed to ensure annual budget
objective compliance for operating expenses, productivity utilization/FTE staffing requirements, use of
resources (capital & supply), etc. Ensures that business office/registration supplies and equipment are
available in the department budget when needed or as planned.

● Strategic Management: Participates in the development and implementation of hospital strategic business
plan/direction; develops and implements the patient financial services/registration goals and objectives for
operational effectiveness consistent with the strategic plan; assists in the establishment of quality &
performance measurement outcomes and monitoring service delivery modification/change, etc. and
maintains current strategic action plans.

● Department Administration: Develops, administrators, evaluates and interprets patient financial and
registration service policies and procedures in a documented system for the hospital; supervises and
monitors the billing and collection processes of the department including, but not limited to: electronic
claims submissions, hard copy claims submissions, claim editing/corrections, cashier/co-payment
collections, claim denials, etc.; establishes methods/processes for posting of accounts, daily deposits,
batch controls of payments receipts; monitors daily the charges for hospital based services by insurance
category (Medicare, Medicaid, private/commercial) to assess total dollar($) amounts billed; monitors
insurance EOB payments by category to determine amounts collected; reviews uncollected amounts and
evaluate for potential bad debt/charity care liability; provides education, training and orientation for both
managers and staff regarding these policies; evaluates and implements operational “best practice” systems
to achieve both efficiency and effectiveness.

● Staffing/Selection: Participates with HR in the recruitment, interviewing, selection, training, and evaluation
of patient financial services/registration employees. Establishes and maintains work schedules to ensure
proper staffing; responds to daily staffing needs/adjustments as needed; monitors staff turnover and
evaluates controllable factors/causes that influence/impact employee separation. Ensures that staffing
levels are consistent with budget requirements.

● Personnel Management: Determines appropriate staffing levels/requirements, as well as
experience/skills/qualifications needed for patient financial services/registration positions; prioritizes and
assigns workload for staff; manages and motivates employee relations/behaviors/performance by inspiring
through coaching, feedback, evaluation, recognition, staff meetings, etc.; conducts performance appraisals
of employees; and disciplines staff as needed. Assesses the employees; technical and professional
education needs and develops or provides educational resources to meet those needs.

● Productivity: Monitors quantity and quality of daily work output for patient financial services/registration
operation and implements any staffing adjustments as needed; monitors overall departmental FTE budget
compliance and reports significant variances to the Chief Financial Officer.

● Customer Service: Promotes a culture of “service excellence” within the patient financial
services/registration department by putting courtesy before efficiency. Ensures that employees understand
customer service departmental goals and expectations and the connection between customer experience
and loyalty to the hospital. Continually seek avenues to provide enhanced customer service and achieve
greater efficiency within the patient financial services/registration department.

● Compliance: Demonstrates knowledge of applicable statutory, regulatory, and administrative requirements
relative to patent admission/registration, patient privacy and rights, HIPPA regulation, insurance claim
processing, financial assistance policies, and collection of payment for services rendered, etc.; accountable
for compliance with regulatory requirements/guidelines and hospital policy.

● Committee Participation: Risk and Compliance committee, and other committees/work groups in which
the involvement of the Patient Financial Services Director is essential.

● Professional Development: Maintains professional and technical knowledge by attending educational
seminars/workshops, reviewing professional publications, participating in other healthcare professional
organizations/societies, and networking with other hospital business office managers. Supports
improvement and innovation in the workplace and promotes community and professional visibility for KVH.

● Performs other duties as assigned.

Salary : $65,978 - $94,578