Manager, Patient Access Services Pediatrics - Main Campus

As an essential member of the Revenue Cycle team, Managers oversee the pre-registration and registration function and successful completion of accurate and timely patient identity and insurance eligibility verification, registration, medical necessity requirements, authorization of services, patient estimates, point of service collections, consent and other forms completion and exemplary customer service while serving the needs of patients and customers. The successful completion of tasks performed by this position, directly impacts quality of the patient's account including timely and appropriate processing of the patient's clinical and financial services and prevention of denials, customer satisfaction and decreases bad debt. Access Managers ensure registration standards are utilized in intake areas outside of purview ensuring consistency with quality and timeliness of patient financial transactions. Manager's lead/own internal and external audit directly related to Patient Access and/or acts in support role where Patient Access is a stakeholder. Managers utilize effective communication skills in patient/physician relations, and maintain current understanding of governmental and payer requirements, employee engagement, training, reporting and use of multiple, complex systems.

What You Will Do

• Facilitates and manages Revenue cycle functions in Access including but not limited to; Eligibility, Authorizations, Medical Necessity, Cash collections, Denial management, Account resolution activities, Quality measures and other UH initiatives (80%)
  

  * Oversight of the patient interview (face-to-face/phone/via document) and utilization of multiple complex applications to create (or validate existing) patient medical record and insurance/bill claim using demographic and insurance information.

  * Mastery of skills relating to insurance coverage, benefits, rules & regulations and allocation of plans accurate information and fulfillment of requirements resulting in expected payment for services

  * Accountable for the verification and allocation of insurance plans utilizing electronic eligibility tools, phone calls payer, accesses web portals and initiates appropriate action for services including non-covered and out-of-network insurance services

  * Accountable for the verification of medical necessity and execution of patient education and acknowledgement of covered and non- covered services.

  * Ensures achievement of registration quality for direct and indirect areas performing function.

  * Analyze unbilled trends to identify people, process and/or technology resolution to permanently resolve; ensure daily unbilled is monitored and performed daily to ensure timely disposition of encounters (or accounts)

  * Oversight of the authorization for services workflow, including escalation, payer requirements and proactive monitoring and productivity to ensure services have authorization before their date of service.

  * Accountable for the successful execution of patient estimate, education to guarantor regarding charges and out-of-pocket liability and establishing payment plans when applicable for professional and technical services.

  * Accountable for the successful pre/point of service cash collection practices completed by direct reports; meeting established goals and benchmarks and enforcing collection guidelines for individual productivity measures.

  * Lead in entity programs/ initiatives that have direct impact to registration /pre-registration ensuring appropriate process, training and outcomes are achieved.

  * Ownership of the eligibility, authorization and pre/point of service collection processes at designated facility and/or service lines.

  * Perform other analysis of department workflow, outcomes, and trends to identity and pursue continuous process improvement.

  * Continue to identify modern approach to pre and registration processes to optimize access, communication and experience.

  * Plans, organizes and executes Revenue Cycle Management and process improvement initiatives.

  * Analyzes and reports out metrics related to Revenue Cycle Access Services and/or Revenue Cycle Management.

  * Works with Finance Department, Payers and Managed care department on Eligibility, strategy and Pre-Authorization Determination Denials.

  * Leads work flow efforts for assigned area; analyzing, reassigning and adjusting based on work needs.

  * Inspires staff to ensure daily cash collection, authorization, eligibility goals are met or exceeded; provides transparency and holds each staff member accountable for successful collections

  * Utilizes electronic reports, worklists, and queues to identify claims requiring updating; makes corrections as needed to ensure accurate and timely billing.

  * Directly oversees staff members, and is responsible for ensuring department productivity standards are met/exceeded.

  * Responsible for all personnel hiring, coaching, and evaluating by completing routine performance reviews regarding expectations, performance and compliance of policies and procedures.

  * Performs duties to promote a positive work environment and leads activities to increase engagement within the department.

  * Creates and Monitors departmental budgets, governmental and regulatory compliance, departmental contracts, and vendor relations.

  * Writes and ensures understanding and adherence to policies and standard operation procedures.

  * Provides on call support (24/7) to staff members to ensure staffing levels are maintained

  * Processes payroll and approves time off requests for direct reports

  
  
• Manages education, training and Revenue Cycle Access processes for department (10%)
  

  * Ensures staff have the tools, access and training needed to successfully meet individual and department key performance indicators, benchmarks and patient experience metrics.

  * Creates reports and dashboards to measure Key Performance Indicators.

  * Ensures staff are compliant and complete required education as establish by the department and the UH enterprise.

  * Responsible for the education and compliance of emergency management procedures for staff/patient tracking and safety.

  
  
• Assists with evaluation, testing and reporting of IT systems in relation to upgrades, code changes and process improvements (10%)
  

  * Evaluates and facilitates system issue discussion and analytic reviews.

  * Ensures testing and training is completed on downstream systems.

  * Works closely with IT and other system owners to give feedback and work out any concerns.

  * Works with vendor on enhancements to the products.

  
  

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.