Manager, Patient Financial Services

The Wright Center for Graduate Medical Education•Scranton, PA

About The Position

The Manager of Patient Financial Services oversees efforts to increase awareness of and access to health coverage and related services for uninsured and underinsured patients. The role ensures patients have opportunities to enroll in appropriate coverage, including ACA plans, Medicaid, Medicare, and other applicable programs. It also oversees Coordination of Benefits (COB), the Sliding Fee Discount Program (SFDP), and the Fee Waiver Program. The Manager serves as a resource on insurance options and supports referrals to the Community Health Worker (CHW) team to promote consistent, accurate outreach, enrollment, and access to financial assistance in accordance with organizational policies and regulatory requirements. The role also provides reporting oversight for billable CCM/CHI services performed by CHW team members, ensuring services are documented, coded, and billed appropriately. This leadership position organizes, plans, and implements activities that directly affect the organization’s fiscal ability to deliver comprehensive, high-quality patient care. It reports directly to the VP of Revenue Cycle and provides guidance to the Manager of Patient-Centered Services regarding CHW education on health insurance enrollment. The Manager of Patient-Centered Services retains responsibility for the CHW team’s overall supervision, performance, and outreach, engagement, and enrollment outcomes.

Requirements

Associate degree or equivalent experience.
Leadership skills in staff supervision and management, including implementing performance metrics, workplans, and project management.
Experience taking initiative, solving problems critically, supporting data-driven decision-making, and delegating and assigning work appropriately.
Ability to work with culturally, socioeconomically, and educationally diverse populations.
Ability to work independently and collaborate and communicate effectively with colleagues, supervisors, and healthcare providers.
Excellent organizational skills and ability to handle difficult interpersonal situations effectively.
Experience with Microsoft Office Suite and Google platform.

Nice To Haves

Buy-in and experience working in the EOS® model (strongly preferred).
Mission-oriented approach and ability to represent the enterprise professionally while demonstrating organizational pride.

Responsibilities

Oversee administration, continuous process improvement, and point-of-care implementation of the Sliding Fee Discount Program for uninsured and underinsured or self-pay patients across clinical and service delivery sites.
Coordinate SFDP application and verification workflows, including specialized intake protocols for patients experiencing homelessness, and monitor operational metrics.
Oversee policies for services not covered under the standard sliding fee schedule and provide timely guidance to clinical and front-desk teams.
Prepare and present quarterly SFDP outcome reports, trend analyses, and quality and compliance assessments to executive leadership and the Board of Directors.
Collaborate with the VP of Revenue Cycle to oversee and administer the Fee Waiver process for patients demonstrating documented financial hardship.
Establish compliant criteria, review mechanisms, and workflows to ensure fair, equitable, and consistent adjudication of fee waiver requests.
Track fee waiver volumes, financial impact, and utilization trends, and report findings quarterly to the Executive Management Team and Board of Directors.
Guide and support the CHW team in resolving COB issues, including unpaid claims and insurance payment retractions, and coordinate timely follow-up with the Manager of Patient-Centered Services.
Support CHW patient outreach and enrollment in health insurance programs and monitor results and performance trends.
Assist with organizational education initiatives on insurance affordability and enrollment through PENNIE and other health coverage programs, including Medicaid, Medicare, and CHIP.
Provide guidance on the ACA and Health Benefit Exchange, serve as an organizational resource, and maintain current knowledge of eligibility, enrollment, and program specifications.
Support the Manager of Patient-Centered Services in ensuring appropriate CHW documentation in CCM/CHI minutes related to insurance outreach, COB issues, and time spent.
Oversee and help review monthly CHI services performed and billed; connect clinical documentation in patient charts to billing outcomes and assist Revenue Cycle with related training.
Serve as a resource for Front Desk, CHW, and Revenue Cycle team members on outreach and enrollment, SFDP, Fee Waiver, COB, and insurance coverage.
Lead and coordinate workflows across Front Desk, CHW, and Revenue Cycle teams to support consistent, compliant processes and effective collaboration.
Analyze data to identify trends, gaps, and opportunities for operational, quality, and process improvements, and implement improvement initiatives as appropriate.
Design strategies and oversee workflows that support access to health coverage and care; establish and document workflows to address service delivery gaps, including use of PDSA tools.
Refer patients with insurance questions, complaints, or grievances to appropriate consumer assistance programs, health insurance ombudsmen, or state or federal agencies in coordination with the VP of Revenue Cycle.
Participate in scheduled calls, meetings, and trainings, including CMS training and other training to enhance outreach and enrollment expertise.
Perform other duties as assigned.