Sr. Manager - Patient Financial Clearance (Remote)

Stanford Health Care

4d•$63 - $83•Remote

About The Position

The Senior Manager-Patient Financial Clearance (PFC) is responsible for oversight of the daily operations for patient financial clearance functions. This includes providing direction and managing the operations team and encompasses responsibility to ensure compliance with SHC and department policies and procedures related to pre-registration, payer authorization and financial counseling functions where applicable to promote optimal performance of the front-end patient financial clearance process/revenue cycle at Stanford Health Care. The Senior Manager is expected to ensure that service lines are properly staffed, and the resources are properly trained to provide timely and accurate financial clearance for all services in scope in PFC. The Senior Manager must have a clear understanding of multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to support timely access to services while maximizing reimbursement and minimizing financial risk to Stanford Health Care. Successful oversight will result in increased net revenues by reducing revenue and cash leakage from potential write-offs due to lack of patient collections and denials. Interactions will primarily be conducted with clinic stakeholders, patients and payors. The Senior Manager will also serve as a decision-making resource to faculty, managers, and clinic staff in financial clearance related issues and escalations.

Requirements

Bachelor's Degree from an accredited college or university with a major in accounting, finance, business administration, health care administration, or a related field (or equivalent combination of education/experience).
Six (6) years of experience in revenue cycle management, i.e. Pre-Registration, Authorization, Financial Counseling in a large, complex healthcare environment including three (3) years of demonstrated progression as a leader and manager of direct reports
Demonstrated familiarity, knowledge and understanding of relevant Hospital Policies, Practices and HIPAA regulations.
Knowledge of Governmental and non-government requirements applicable to patient financial clearance processes
Strong organization and decision-making abilities.
Strong knowledge and experience in an environment of multiple managed care contracts, multiple specialty services, insurance and billing practices, and provider networks, especially the differences between participating and non-participating providers
Demonstrated professional competency in reviewing patient accounts to address root cause of issues, maximize reimbursement and minimize financial risk to Stanford Health Care.
Strong business communication skills including communicating well verbally and in writing with senior/executive leadership and patients.
Receive and disseminate information effectively and appropriately, reviewing and acknowledging unit
Ability to facilitate effective interpersonal and professional relationships at all employee and management levels
Ability to provide leadership in problem identification and issue resolution.
Ability to facilitate groups.
Problem solving abilities, prioritizing, multi-task, meet deadlines and adapt to changing priorities
Demonstrated knowledge and understanding of the Pre-Registration, Authorization, Financial Counseling functional areas:
Demonstrated project management skills including managing multiple projects in a timely and efficient manner.
Demonstrated abilities in utilizing Lean/project management principles for efficient workflows.
Demonstrated analytical, problem solving abilities, strong organization and decision-making abilities with data, people and situations.
Ability to collect, organize and analyze data to identify trends and opportunities, present the data to a variety of audiences and implement appropriate countermeasures.
Demonstrated knowledge and understanding of Registration (Epic) and billing systems (Epic) and databases.
Demonstrated skills and proficiencies of Microsoft Excel, Word or other spreadsheet and/or word processing software.
Demonstrated ability to work independently with strong follow-up skills to ensure effective and efficient completion of tasks.
Current knowledge of third party payer rules and regulations.
Knowledge of ICD-10 and CPT coding.
Knowledge of medical terminology.

Responsibilities

Working with the Director, effectively lead and coordinate initiatives and operations with hospital clinic leadership and other leadership representatives and stakeholders from various departments associated with Patient Financial Clearance operations.
Support the Director in developing strategies for operational improvement, assists with budget development, and departmental reporting.
As a member of the Revenue Cycle leadership team, the Senior Manager serves as a key resource to promote best practice revenue cycle processes and strives to meet and exceed the needs of its customers.
Represent the department in clinic senior leadership communications, participate on various committees.
Provide guidance to financial clearance managers to ensure the department functions are performed efficiently throughout the department
Ensure staff and management team are adequately trained to handle business functions required to financially secure all accounts in the scope of the department including but not limited to pre-registration tasks such as, insurance and benefits verification, regulatory requirements, i.e. Medicare Secondary Payer Questionnaire (MSPQ), Advanced Beneficiary Notice (ABN), securing appropriate pre-certifications or authorizations and collecting payments for upcoming services
Serve as one of the primary points of contact for clinic leadership to communicate business initiatives and address escalations.
Serve as a primary decision maker to effectively handle financial clearance escalations
Proactively identify and quickly respond to revenue cycle issues and provide leadership for root cause analysis and problem resolution.
Provide financial clearance service approach for providers, patients and family from point of contact through charging.
Utilize feedback and needs assessment tools to understand internal and external customer expectations.
Strive to provide services that exceed expectations and work to eliminate barriers to good service.
Maintain relations with all internal applicable parties in the enterprise, third party payers, and other agencies, as appropriate.
Develop goals and priorities for the Patient Financial Clearance and assigns tasks and projects.
Design and implement appropriate plans to meet goals.
Develop staff skills and training plans.
Counsel, trains and coach managers and assigned staff.
Implement corrective actions and conduct performance evaluations.
Implement corrective actions and conduct performance evaluations.
Provide leadership, direction and guidance.
Lead the implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise.
Monitors to ensure that integrity and accuracy of registration data is maintained by department.
Works collaboratively with other departments to ensure the processes and systems for patient financial clearance processes are standardized and optimized for efficient and effective flow of patients within the department and through the organization.
Ensure an ongoing procedure for accurate and timely gathering of patient information, securing patient’s insurance coverage limits and benefits and communicating to patients for meeting the financial expectations of the hospital as applicable.
Ensures that these functions are performed efficiently throughout the enterprise, which includes maintaining an adequately trained staff to handle all patients in both inpatient and outpatient clinic settings.
Maintains a complete record of current policies and procedures followed by staff in the director’s areas of responsibility; responsible for having complete knowledge of the patient flow and steps taken by staff to complete these procedures; assures that staff is adequately trained and meets competency requirements and levels.
Remain current on all regulatory and accrediting agency requirements, including Federal and State regulations and Joint Commission standards as they relate to Registration.
Ensures compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed; i.e. Medicare Secondary Payer, authorization for inpatient and outpatient services, and verification of eligibility or other primary coverage.
Assures compliance with the medical staff bylaws, rules and regulations, and hospital and departmental policies and procedures.