Manager, Financial Clearance

DCH Health Care Authority•Tuscaloosa, AL

12h•Onsite

About The Position

Manages the financial clearance functions for DCH Regional Medical Center, setting goals, priorities, performance standards, policies and procedures for Good Faith Estimates, insurance/benefit verification, Financial Counselors, Alabama Field Navigator, Patient Financial Assistance Program, and Post-Reg. This position holds key responsibilities that directly impact reimbursement and the hospital’s financial performance. The role will also be involved in departmental and interdepartmental process improvement teams to eliminate waste and improve efficiency.

Requirements

Associate Degree OR prior advocacy experience or applicable Revenue Cycle Experience of a least two years in a healthcare setting.
Good Communication skills.
Ability to read, write and speak English.
Ability to interact well with the public and staff.
Understanding of all regulatory, HIPAA and payer guidelines.

Responsibilities

Oversee Financial Counselors, Alabama Field Navigator, and Post-Reg staff.
Interview patients to obtain legal relevant medical information and all required documentation for eligibility determination and accurate application completion to avoid rejections/delay in payment and increase AR.
Screen and evaluate patients for existing insurance coverage, federal and state assistance programs or hospital charity application.
Screen uninsured patients for state and federal insurance programs; Medicaid, All Kids Marketplace, Medicare or VA Programs.
Work with vendors, billing, and/or case management to ensure secured reimbursement to DCH prior to services or before patient is discharged and mitigate at risk accounts from moving through collection process.
Work with both sides of the revenue cycle management to align revenue cycle processes to present a unified patient experience and consistent capture for Clean Claim Processing.
Provide reports and analysis to Assistant Director on insurance discoveries or secured Medicaid, Marketplace or charity applications.
Counsel patients on insurance benefits, copayments, and coinsurance amounts.
Assist patients with payments, payment plans, or applicable options to ensure DCH is reimbursed for services rendered.
Operate as collector to accept patient payments via cash, credit or checks.
Document applicable systems and provide patient receipts.
Ensure all insurance, demographic, and eligibility information is entered into the EMR accurately and appropriate signatures are obtained on all required forms for clean claim processing.
Serve as a liaison between the patient, hospital and governmental agencies; actively involved in financial areas of case management for supportive patient advocacy for best patient experience.
Initiate and complete charity application on at risk accounts or items not obtained at the time of registration to avoid financial loss or payment denial for DCH.
Maintain proper follow-up with the patient and governmental agency caseworkers to ensure timely processing to include request for additional information.
Work report each week and document account notes of application status for all pending applications.
Escalate at risk accounts to leadership.
Review financial data and multiple program requirements to determine possible Marketplace eligibility or other government insurance.
Assist with optimizations of Patient Access software and rollouts.
Exercise problem solving skills independently or within a group setting for best financial outcomes.
Verify or re-verify benefits or initiate or obtain authorization and/or referrals to include validation of traditional or HMO plans, commercial coverages within payer timelines to ensure reimbursement to DCH.
Work collaboratively with Case Management and Discharge Planning for awareness of community resources to engage patient and family members as needed.
Monitor the accuracy of demographic and insurance information obtained by staff for patient registrations and authorizations.
Monitor billing edits to ensure accurate and timely claims submission.
Investigate errors, suggest changes and/or implement solutions to encountered problems.
Escalate issues to Revenue Cycle leadership when appropriate.
Prepare, maintain and balance yearly budgets for applicable cost centers.
Manage budget over the fiscal year.
Develop, recommend and implement policies and procedures for the department.
Monitor adherence to policies and established procedures.
Propose methods which assure effective execution of program responsibilities.
Maintain performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
Perform compliance requirements as outlined in the Employee Handbook.
Adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Perform essential job functions in a manner that ensures the safety of patients, visitors and employees.
Identify and reduce unsafe practices that may result in harm to patients, visitors and employees.
Recognize and take appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Adhere to all DCH Health System policies and procedures.
All other duties as assigned.
Manage departmental budget.
Interview, select, hire, and retain employees.
Ensure orientation and training for employees.
Manage performance.
Promote, demote, or transfer employees to meet organizational needs.
Execute employee accountability process up to and including termination.
Manage departmental productivity standards.
Perform compliance requirements.
Approve payroll and is responsible for accurate payment of employees.
Manage front line operations of area of accountability related to meeting/exceeding departmental goals.