Rev Cycle Site Manager and Financial Counselor

Perry County Community Hospital- training at Henderson County Community Hospital will be required.

Summary:

The Patient Access Manager is responsible for coordination and supervision of the Registration, Emergency Department, and scheduling staff, as well as the daily Financial Counselor position duties. This position requires a detailed knowledge base in registration, emergency department and scheduling protocols and billing practices, as well as an understanding of how these areas impact the flow of work throughout the departments and organization. The Manager is responsible for implementing and enforcing policies and procedures, monitoring the accuracy of registration and scheduling data entered by associates, ensuring that proper patient experience protocols are followed, and clearing issues in various registration and billing work queues, and managing the overall training and coordination of work for the department.

Included in the supervision of these areas is preparation of staffing schedules and recommendation and coordination of program-related improvements and changes. The individual will have knowledge in the hospital purchasing process and cost containment methods of the Patient Access Department. In addition, this position is also responsible for providing information for and assisting with budget preparation.

The Financial Counselor is responsible for providing patients with a positive financial experience by aiding in navigating and understanding insurance benefits and potential financial liability. The Financial Counselor collects and posts payments and deposits all monies collected, establishes short term payment arrangements, creates out of pocket liability estimates, advises patients of their insurance policy benefits and coverage and financial obligations. The Financial Counselor is the patient’s point of contact for billing questions. The Financial Counselor will assist patients with eligibility for government programs and other options for managing their medical liabilities. The Financial Counselor assists patients with applying for Tennessee State Medicaid and financial assistance through Haywood County Community Hospital. The Financial Counselor reviews all financial assistance applications for determination, advises the patient of the determination, and applies applicable adjustments to the patient’s account(s). The Financial Counselor reviews self-pay accounts, determines if the patient has active coverage not identified during the registration process and works with patients to resolve financial liabilities for both current visits and past visits that may have outstanding balances. For past due balances, the financial counselor will reach out to the patient to offer assistance in resolving the balance. The Financial Counselor will apply the determined self-pay discount to patient accounts as appropriate. The Financial Counselor acts a resource to registrars with insurance, eligibility, and other questions to ensure accurate completion of demographic and insurance information for service encounters.

The position requires the ability to independently plan, schedule, organize and respond appropriately on a wide variety of subjects and situations. The ability to perform the duties of the staff supervised is required. As hospital reimbursement, patient experience, and provider schedules are dependent upon the activities of the Patient Access Department, timely completion of duties and follow-up is critical. Involvement in departmental and interdepartmental process improvement activities would also be expected of the individual.

A substantial portion of the normal duties requires proper judgment, sensitivity, and adherence to the organization’s policy on confidentiality. The individual has access to patients’ medical information, as well as financial information. The individual maintains and has access to confidential departmental personnel files.

Duties and Responsibilities:

• Maintain knowledge of organizational policies and procedures.
• Develop staffing schedules and assure staffing needs are met. Implement alternative staffing patterns as needs arise, taking into consideration department budgetary constraints and performance requirements and restrictions.
• Participates in the Interview and hiring decision process to maintain adequate staffing in the department.
• Review and process timecards in an accurate and timely manner. Maintain accurate employee attendance files.
• Encourage and commend staff for excellent performance.
• Provide timely performance improvement feedback and coaching. Participate in progressive discipline when warranted by inappropriate employee behavior or inadequate work performance.
• Conduct timely training assessments, reclassification exams, and performance reviews. Solicit feedback from other staff and managers as appropriate.
• Respond to employee questions/concerns on an individual basis as needed.
• Conduct team meetings to apprise staff of changes and to address broader-based program area issues and initiatives.
• Participate in on-call rotation for off-hours staffing issues, escalations, and staff questions.
• Participate in the development and implementation of policies and procedures for the department.
• Monitor adherence to policies and established procedures. Propose methods which assure effective execution of program responsibilities.
• Apprise staff of changes.
• Personally perform functions supervised.
• Ensure that patient experience and service standards are met.
• Uses reports and dashboards to monitor and report the daily productivity of the work performed for the department and individuals.
• Monitor and report the accuracy of the data entry of demographic and insurance information obtained by staff for patient registration. Investigate errors, suggest changes and/or implement solutions to encountered problems.
• Monitors accuracy of scheduling functions, provider templates and makes recommendations on template changes to best utilize providers time, while ensuring patient satisfaction.
• Enforces established policies and procedures, including work rules, safety procedures, confidentiality standards, accreditation standards, and CMS standards.
• Monitors work queues and reports to ensure accurate and timely registration, scheduling, and claims submission.
• Maintains a solid understanding and knowledge of payer requirements, registration, and scheduling workflows, as well as referral requirements to ensure staff follows established procedures to maximize reimbursement.
• Tracks common issues and provide training to staff to prevent the issue from reoccurring.
• Gather and analyze departmental and program specific productivity and quality of service statistics.
• Work collaboratively with other departments on issues relating to patient registration, scheduling, patient flow, insurance verification, referrals, and reimbursement issues. Represent the department in meetings and on committees relating to these issues.
• Serve as the knowledge expert and information source for staff. Keep abreast of insurance, referral, and billing requirements. Request system enhancements as needed to facilitate accurate registration and scheduling.
• Serve as an escalation point for patient issues and questions. Assist staff with complex and disgruntled patient situations requiring intervention from a higher authority.
• Responsible for building and maintaining relationships with patients in the community.
• Participate in process improvement teams as assigned.
• Assist with application implementation, upgrades, enhancements, and usability testing.
• Assure equipment is in working order. Recommend the purchase of new equipment as required.
• Provide information for budget preparation.
• Provide new employees with orientation to department.
• Develop and/or update training modules. Keep accurate records of personnel training schedules as well as training checklists.
• Train and delegate appropriate training responsibilities for new and current staff. Schedule and facilitate cross-training of employees.
• Observe and modify training schedules as needed to include new methodologies and concepts. Conduct training review sessions.
• Actively seek and schedule staff development opportunities, including those outside the department that would be beneficial for staff members to attend.
• Monitor trainee progress and trainer effectiveness based on feedback.
• Identify focus areas for competency assessments. Provide training opportunities addressing areas highlighted by these assessments.
• Participate in training/development programs as agreed upon with the Patient Access leadership.
• Serves as the point of contact for all financial assistance related questions.
• Communicates with patients to identify and understand financial, social, and other relevant patient information.
• Gather all relevant information required to process financial assistance requests.
• Assess the current financial situation of patients through verification of patient insurance benefits, serving as the technical expert in confirming benefit coverage and hospital reimbursement.
• Conducts financial screening by reviewing submitted financial assistance applications and supporting documentation to determine eligibility for financial assistance and/or other coverage options.
• Assess and offer payment alternatives which may include pre-payment for elective care, applying for the hospital’s financial assistance program, or other available coverage options.
• Assist patient in completing application for eligible programs and in completing any required documentation for acceptance.
• Assist in obtaining exceptions to the out of network determinations from insurance carriers, escalate as necessary.
• With provider involvement, determine urgency of scheduled care for patients with large financial liabilities resulting in the decision to proceed or to defer.
• Explain HCCH’s payment policy to assist patients if determined ineligible for coverage options.
• Counsel patients on out-of-pocket liabilities.
• Complete cost estimation for services upon request. Communicate estimated liability amount to requestor.
• Collect patient out of pocket liability amounts including deductible, co-payments, open patient balances on accounts not settled.
• Works with patients on establishing appropriate short term payment plans.
• If unable to establish acceptable payment arrangements for elective procedures, inform provider and patient that services will be deferred until payment arrangements are secured.
• Works self-pay accounts by contacting patients post service to screen for coverage options, establish payment schedule, or other appropriate arrangement.
• Provides patient financial counseling services to uninsured and underinsured patients prior to, at time of, or post service.
• Enters clear documentation of all patient financial counseling activities into the patient account notes.
• Communicates coverage information to all relevant parties such as case management and patient financial services.
• Obtains signatures from patients or their legal representative if incomplete at time of admission to the hospital.
• Consults with supervisor as needed to resolve account issues.
• Adheres to hospital policy regarding patient rights including right to privacy and confidentiality.
• Reviews patient account detail for accuracy according to established department key performance indicators.
• Maintains a professional image and demonstrates service excellence with every encounter.
• Must be able to pass drug screens, both pre-employment and throughout duration of employment.

Knowledge, Skills, and Abilities:

• Good oral and written communication skills.
• Demonstrates age specific competency.
• Demonstrates understanding of Medicare and third-party payer coordination of benefits policies and procedures related to the admission and registration function.
• Knowledge of medical billing requirements, third party payers, coordination of benefits, scheduling practices.
• Knowledge of managed care referral and prior authorization requirements as they relate to hospital reimbursement.
• Demonstrates cash management skills.
• Ability to interact professionally, courteously, and efficiently with the public, coworkers, and payor contacts.
• Demonstrates good judgmental and the ability to make decisions effectively.
• Ability to interact with patients calmly and treat them with dignity and respect, even in stressful conditions.
• Ability to perform registration routines in the hospital’s health information system accurately and timely.
• Knowledge of HIPAA regulations and demonstrates the ability to keep protected health information confidential.
• Good time management and organizational skills.
• Proficient in Microsoft Office applications.
• Knowledge of medical terminology.
• Demonstrated performance excellence and leadership qualities in previous positions
• Demonstrates an aptitude and willingness to learn new responsibilities
• Ability to work independently, make decisions, meet deadlines, and solve problems, working under a moderate to high degree of pressure
• Knowledge of revenue cycle policies and procedures.
• Knowledge of payer contracts.
• Knowledge of health insurance payors.
• Proficiency in PC software, especially word processing and spreadsheet programs
• Experience with a hospital-based computer system

Work Experience, Education, and Certifications:

• High School graduate or equivalent.
• Must have at least 4 years of experience in the revenue cycle process, or 2 years’ experience in a related leadership role.

Physical Requirements / Demands:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift 15 pounds.

Essential or Non-Essential Classification:

• This position is designated as an essential position and therefore the employee’s presence at work during an emergency or bad weather conditions is required to meet operational needs.

Statement of non-inclusivity:

• This job description has been designed to describe the general nature and level of work being performed by the employee within this classification. It is not designed to contain or be interpreted as a comprehensive list of all duties, skills, responsibilities, and qualifications which may be required of or given to any employee assigned to the position. The skills, duties, requirements, and responsibilities outlined in this job description may be changed or added to when deemed appropriate and necessary by the company or the person who is designated to be managerially responsible for this position. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind. Employment with the company is an at-will relationship.