Manager, Patient Financial Services

The Wright Center Medical Group•Scranton, PA

About The Position

The Manager of Patient Financial Services oversees activities that increase awareness of and access to health coverage and related services for uninsured and underinsured patients. The role ensures patients are offered 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, and provides guidance on insurance options and referrals to the Community Health Worker (CHW) team. This leadership position organizes, plans, and implements activities with a direct fiscal impact on the organization’s ability to deliver comprehensive, high-quality care. The Manager supports compliant and consistent outreach, enrollment, and financial assistance processes across all service locations and oversees reporting on billable CCM/CHI services performed by CHW team members, including documentation, coding, and billing. The position reports directly to the VP of Revenue Cycle. It serves as a resource to the Manager of Patient-Centered Services for CHW education related to 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 supervision and management of staff, including implementation of performance metrics, workplans, and project management.
Experience taking initiative, solving problems critically, ensuring data-driven decision-making protocols, and delegating and assigning work appropriately.
Ability to work within a culturally, socioeconomically, and educationally diverse population.
Ability to work independently and collaborate and communicate effectively with colleagues, supervisors, and health care providers.
Excellent organizational skills and ability to handle difficult interpersonal situations effectively.
Experience with MS Office Suite and Google platform.
Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool.

Nice To Haves

Buy-in and experience working in the EOS® model (strongly preferred).
Mission-oriented approach; represents the enterprise professionally and demonstrates organizational pride.

Responsibilities

Oversee administration, continuous process improvement, and point-of-care implementation of the Sliding Fee Discount Program across clinical and service delivery sites.
Coordinate SFDP application and verification workflows, including specialized intake protocols for patients experiencing homelessness, and monitor operational metrics.
Provide guidance on services not covered under the standard sliding fee schedule, including specified medications, vaccines, and specialized procedures.
Prepare and present quarterly SFDP outcome reports, trend analyses, and quality and compliance assessments to executive leadership and the Board of Directors.
Oversee and administer the Fee Waiver process in collaboration with the VP of Revenue Cycle, including compliant criteria, review mechanisms, and workflows for fair and consistent decisions.
Track fee waiver volumes, financial impact, and utilization trends, and report findings quarterly to the Executive Management Team and Board of Directors.
Support the CHW team in resolving patient Coordination of Benefits issues, including unpaid claims and insurance payment retractions.
Coordinate timely follow-up with the Manager of Patient-Centered Services on coverage and billing issues and facilitate appropriate reimbursement for services rendered.
Support CHW patient outreach and enrollment in health insurance programs and monitor results.
Assist with organizational education about 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 and maintain current knowledge of eligibility, enrollment, and program specifications for applicable coverage programs.
Advise the Manager of Patient-Centered Services as needed on 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, and connect clinical documentation in patient charts with monthly billing outcomes.
Assist the Revenue Cycle team with training related to documentation and billing.
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 promote consistent, compliant processes and effective collaboration.
Analyze data to identify trends, gaps, and opportunities for operational, quality, and process improvement, and implement improvement initiatives as appropriate.
Design strategies and oversee implementation workflows to ensure 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 ombudsman, or other 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.