Patient Access Lead

Guidehouse•Ventura, CA

2d•$65,000 - $108,000

About The Position

The Patient Access Lead, in partnership with the Patient Access Supervisor, Manager and Director are responsible for the proactive oversight, of client relationships and strategic initiatives, to ensure quality measures in front-end patient intake operations are consistently met. This role provides guidance to frontline staff, ensures operational practices are in compliance with State and Federal healthcare regulations (including but not limited to HIPAA, EMTALA and NSA) and serves as one of the communication links between Patient Access and our client’s administrative and clinical partners. The Lead is a Subject Matter Expert (SME), dedicated to maintaining high – quality data integrity and engages the Patient Access Trainer on developing and putting to practice standardized operating procedures that keep the team informed of evolving workflow updates and or operational compliance requirements.

Requirements

High School Diploma required; University degree or vocational certification in Healthcare Administration preferred.
4-8 years of experience in Customer Service, Patient Access, Medical Billing and or Healthcare Revenue Cycle

Nice To Haves

Advanced proficiency in Electronic Health Records (Epic, Cerner, etc.) and data analysis.
Expertise Robust knowledge of medical terminology, insurance verification, and federal healthcare mandates.
Ability to assess priorities in a high-volume, high-stress environment and provide empathetic leadership.

Responsibilities

Operational Leadership & Communication
Team Guidance: Leads a team of Patient Access Representatives, providing daily guidance to ensure tasks like registration, insurance verification, and financial counseling are completed accurately.
Strategic Alignment: Establishes and monitors key performance indicators (KPIs) such as wait times, point-of-service collections, and clean claim rates.
Stakeholder Liaison: On occasion, communicates with hospital leadership, clinical departments (ER, Surgery, Imaging, Case Management, Patient Safety and Compliance), and external payers to resolve complex patient account issues or process bottlenecks.
Compliance, Innovation & Quality
Regulatory Oversight: Monitors departmental compliance with State and Federal laws impacting patient intake operations, ensuring all staff adhere to patient privacy practices and billing guidelines.
Process Improvement: Acts as an SME to identify “pain points” in the claim journey; proposes and implements enhancements to the registration workflow to improve the overall patient experience.
Complex Problem Solving: Resolves moderately complex issues involving mismatched patient identities, coordination of benefits (COB), or operational opportunities for improvement that impact procedure/service authorization matters.
Talent Management and Training
Staff Development: Responsible for ensuring staff training compliance requirements are met, delegating, and reviewing the work of junior staff to ensure a high level of data quality and professional patient interaction.
Resource Creation: Is aware of where to obtain Educational Learning Resources (ELRs) and “tip sheets” for various workflows completed in the hospital’s software (EHR/EMR) systems.
Project Oversight: May manage specific departmental projects, such as the implementation of new check-in technology (Epic My Chart), a new financial clearance workflow, within defined budget parameters and or the expansion of registration services to auxiliary departments/service lines.
Provide Lead cross-departmental support in ED, Mother Child Health, Same Day Surgery, Pre-Registration, Outpatient Registration (Main Admitting), PBX Communications.
At the discretion of upper management, lead meetings with client clinical and or administrative leadership.
Assist client’s effort of neutralizing multi-million-dollar impact by 1. Minimizing Do Not Bill days 2. Accelerate claim adjudication by addressing Claim Edit and DNB Workqueues trends.
Analyze opportunity for improvement patterns and trends, categorize root-causes per technology, workflow and or isolated vs. systemic causes.
Partner with leadership on establishing Quality Assurance measures that address and minimize the impact of trended opportunities rooted in workflow.
Escalate to client’s IT leadership opportunities categorized and rooted in technology.
Provide staff guidance to assure quality in registration, admissions, insurance verification and PBX Communication operations which include but are not limited to: o Client Software application - TempTrak monitoring of temperature, pressure, and humidity across hospital equipment and environ- ments, ensuring regulatory compliance and maintaining accurate records. o Monitoring of software applications and tools which identify fire loca-tions within the client’s facility. o Adherence to client’s crisis and emergency management plan activa tion requirements associated with PBX.
Monitor and partner with upper management on productivity, quality, and service standard findings.
Generate reports and or Electronic Health Record Dashboards which demonstrate performance metrics.
Partner with upper management on workflow design, development, orientation and implementation.
Support upper management in the maintenance of and staff’s adherence to standardized operating procedures.
Address patient escalations real-time and or engage upper management when appropriate.
Provide front-line operational support when coverage gaps are present and or during patient high census.
Analyze daily operations and patient census across the various services lines and present upper management with staff reassignment recommendations when optimization opportunities are present.
Ensure staff adherence to State and Federal meal and rest break requirements.
Partner with upper management in the development of workflow standards to address operational opportunities for improvement.
In partnership with the Patient Access Trainer, assist in ensuring GH New Joiners are assigned a department preceptor and help facilitate GH New Joiner interdepartmental training.
In partnership with upper management, lead hospital emergency and crisis response and mitigation plans.
Ensure staff conduct aligns with GH Code of Conduct expectations and exemplifies behaviors of excellence that facilitate a positive work environment.
Adhere to and help ensure staff adherence to both GH and client learning and development assignments and initiatives.
Lead audit/root-cause investigative findings meeting with client/hospital clinical leadership and or client administrative leadership.
Provide coaching of Patient Access best practices to client’s decentralized patient access/patient intake leaders and or areas that do not fall within Guidehouse Leadership reporting structure.
Provide mentorship and non-disciplinary coaching to front-line staff.
Support Supervisory functions if and when the Supervisor is unavailable (excluding disciplinary discussions with front-line staff).
Work under minimal supervision, effectively manage time and competing priorities.
Apply knowledge of Microsoft Word, Excel and or Power Point to present data and or construct summary of audit, root-cause and or investigative findings.
Consistently demonstrate excellent customer service and service recovery when escalations present themselves.
Effectively apply knowledge of medical terminology and revenue cycle terminology.
Offer flexibility to support operational needs, including occasional coverage for areas that run 24/7.
Co-lead planning and implementation of client software application activations (e.g. implementing an EHR or payment processing system).
Performs all other duties as assigned.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program