Manager, Denial Prevention Analyst I - Patient Access
This position is responsible for providing leadership and overseeing the pre-registration and pre-service collections functions within the Patient Assistance Center. Successful oversight will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and denials. Interactions will primarily be conducted with patients and results of efforts will drive actions to secure payment for scheduled and unscheduled patients.
- Support, oversee, and manage the performance and productivity of the team as it relates to pre-registration activities and pre-defined goals/targets, while providing continual feedback and guidance to the team
- Ensure the team's ability to obtain and record accurate demographic and other financial and clinical information necessary for the financial clearance of scheduled patient accounts prior to services being provided
- Ensure pre-registration staff collect and validate all required data elements for accurate hospital registrations and admissions in revenue cycle systems
- Manage the team's ability to perform insurance eligibility and follow-up activities with patient and/or referring physician office in the event of failed eligibility
- Ensure the team's ability to accurately confirm eligibility of patient coverage benefits, including patient responsibility, effective dates
- Support activities to notify patients of their liabilities prior to date of service as determined by insurance benefits and coverage limits, and collect liabilities per department guidelines
- Ensure that denial prevention analysts and team leads refer patients to financial counseling per department guidelines
- Meet or exceed predetermined productivity standards, recommending new approaches to enhancing performance and improve productivity when appropriate
- Manage the maintenance activities of appropriate records, files and timely and accurate documentation in revenue cycle systems
- Ensure that leads provide timely feedback to staff and address performance / quality and training issues as appropriate
- Assist with providing hands-on training to new employees and working with existing employees who require retraining or need to learn a new aspect of their job
- Provide coaching and mentoring to less experienced team members on all aspects of payor issues, policy issues, or anything that impacts their role
- Perform daily accuracy reports and quality assurance reviews of patient accounts as directed
- Manage efficient and effective operational policies, processes and performance monitoring within pre-registration and financial clearance
- Assist Executive Director, Revenue Operations to routinely conduct payor trend analysis to ensure optimal processing and reimbursement, identify issues, communicate findings to Steward revenue cycle stakeholders, define solutions and initiate resolution
- Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
- Commits to recognize and respect cultural diversity for all customers (internal and external).
- Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
- Performs other duties as assigned
- Bachelor's Degree (BA or BS) with emphasis in Business Administration and/or Healthcare, required.
- Master's Degree with emphasis in Business Administration and/or Healthcare preferred.
- 5+ years of experience in healthcare Revenue Cycle setting (i.e. registration, financial clearance, billing, etc) with at least 2 years of supervisory experience.
- Comfort with data entry within Revenue Cycle software, patient management systems and Windows based applications preferred.
- Strong competency with Microsoft Office (Excel, Word, PowerPoint) is required.
- Strong experience with patient accounting system and strong knowledge of word processing, spreadsheet applications and the internet
- Demonstrates a detailed working knowledge of Patient Access procedures and healthcare reimbursement to include familiarity with various payor mixes
- Ability to establish personal and professional credibility with Steward Health's Executive Director, Revenue Operations, overall executive team, and revenue cycle leadership and staff throughout the System
- Clear understanding of the impact financial clearance services have on revenue cycle operations and financial performance
- An enthusiastic coach with demonstrated ability to recruit, mentor, train and develop staff, and monitor performance
- Clear understanding of regulatory requirements to ensure that all revenue cycle operations are compliant, e.g. knowledge of government and non-government third party benefit and coverage rules
- Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality
- The ability to passionately model the basic values of the philosophy, mission and vision of Steward Health
- Exceptional interpersonal, communication and presentation skills, and the ability to clearly articulate goals and expectations across the organization
- The ability to prioritize and manage multiple tasks simultaneously, effectively anticipate and respond to issues as needed in a dynamic work environment
- Exceptional communications and customer service skills
Job Status: Full Time
Job Reference #: 55609