Employment Status: Full Time
The LGH Patient Access Manager will oversee the day to day operations of the Central Call Center including, but not limited to, patient scheduling, pre-registration, insurance verification and pre-authorization. In addition, the manager will serve as a communication resource to ensure system-wide dissemination of Patient Access policies, procedures and process changes throughout LGH.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Demonstrates knowledge and understanding of registration and financial clearance requirements including:
o Completion of required comprehensive pre-registration/registration information, including the accurate entry of demographic and financial information within the Cerner system.
o Ability to leverage available systems and tools to identify when authorization is needed and submits requests when necessary for both outpatient and inpatient services.
o Knowledge of commonly encountered insurance plans, payer requirements and the different benefit structures by plan type and can appropriately select the appropriate payer and plan for the encounter.
o Ability to correctly explain the patient s financial liabilities to the patient and obtain payment or establish payment plans prior to services.
o Validation of medical accessibility in accordance with Center for Medicare &Medicaid Services (CMS) standards and communication of relevant coverage/eligibility information to the patient.
Ability to act as liaison between the Patient Access Systems Director, Patient Accounts and Patient Access Leaders from UHC, AGH, SMH, OCSP, LGSH and the Cancer Centers.
Ability to effectively communicate changes in policies or procedures to impacted departments and facilities, including Patient Accounts and regional Patient Access locations.
Demonstrates ability to maintain required records and reports.
Demonstrates leadership that fosters growth and development of staff.
Ability to maintain physician, and intra/inter departmental communication and cooperation, specifically researching and resolving delivery of care issues as they arise.
Sets specific standards and objectives for intra departmental processes collaboratively with Director and other management staff.
Provides orientation, training, and information concerning continuing education for staff, and participates in the formal teaching program/in-service education as required assuring staff training and competency in all disciplines.
Promotes an environment in which the patient care team can work cooperatively with the call center toward quality service and standards.
Ability to delegate responsibilities within the scope of personnel abilities.
Works collaboratively with the Systems Director, assists with department budgets, and assists with monitoring and reporting compliance.
Knowledgeable in regulatory requirements, i.e., federal and State laws, JCAHO, OSHA Safety, etc., as the requirements relate to the call center.
Responsible for the development and continuation of a comprehensive quality-monitoring program by staff in the call center.
Responsible for maintenance of departmental procedures.
Evaluate staff for merit increases, promotions, transfers, disciplinary actions and separation of service.
Participates in resource utilization such as staffing payroll review and supplies in the call center.
Bachelor s Degree with three (3) years of experience in related field.
Proven ability to work collaboratively in group settings with various stakeholders, including executive leadership and clinicians.
3-5 (Three to Five) years of experience in call center operations is required, preferably in a healthcare environment.
1-2 (One to Two) years of healthcare operations experience, required.
Understanding of call center infrastructure and technologies is preferred.
Three (3) years of supervisory experience, required.
Requires problem solving skills, critical thinking skills, and the ability to multi-task.
Knowledge of Medicare and Medicaid regulations.
Demonstrated strong written and verbal communication skills. Ability to listen actively and respond to employees, physicians, patients and payer issues in a competent manner.
Knowledge of admitting, general registration, ED registration, financial clearance, precertification, and central scheduling.
Demonstrates strong organizational skills by proactively prioritizing needs and effectively managing resources.
Demonstrates strong leadership skills by guiding individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services.
Articulates knowledge and understanding of organizational policies, procedures and systems.
Demonstrates proficiency in Microsoft Office applications, registration system, insurance verification and other revenue-cycle software.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
Sits and walks throughout the day.
Handling office supplies and equipment.
Speaking and listening skills are important to communicate effectively.
Medium Work as defined by the U.S. Department of Labor constitutes a maximum lift of 21-50 pounds on occasion and/or a maximum lift of 11-25 pounds on a frequent basis
Formal application; verification of education, and experience; verification of license(s), certification(s), registration(s), accreditation(s) if applicable; oral interview, reference and background checks; job related tests may be required
Formal application; verification of education, and experience; verification of license(s), certification(s), registration(s), accreditation(s) if applicable; oral interview, reference and background checks; job related tests may be required.
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, skills, and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must comply with all SERVICE Standards of Behavior