JOB SUMMARY:
A system-level position accountable for planning, organizing, managing, and leading all aspects of Stamford Health financial clearance operations within the Revenue Cycle Department including the Pre-Service Financial Clearance unit. This position will ensure optimal use of all resources to achieve departmental goals for productivity and other performance indicators for applicable financial results determining workflow priorities and effective methodologies to complete tasks. Generating both routine and ad-hoc reports, this position serves as a senior resource to staff and is accountable for employee training, management and supervision, and the professional development of this role’s direct reports.
The Manager leads the Pre-Service Finance Clearance (PSFC) team ensuring that staff members accurately obtain patient benefits/coverages, validates medical necessity, initiates, and statuses authorizations and/or pre-certifications timely, as required, according to the specific test/procedure being scheduled and performed, and pre-registers patients prior to the date of service. The position is responsible for running a smooth operation by staffing the department to meet performance standards in obtaining financial clearance for in-scope scheduled and, where relevant, unscheduled patient accounts meeting timeline standards established by Leadership for patient services across the organization
Key Responsibilities:
- Manages the Pre-Service Financial Clearance department including prior authorization, medical necessity, verification, and pre-registration operations in a manner that ensures patients are processed appropriately according to the most current policies and procedures.
- Oversight of the referral process to Financial Counseling to identify conversion opportunity for uninsured or under-insured population.
- Ensures proper financial communication during pre-registration process that includes creating a patient liability estimate and collection of patient liability or prior balances.
- Responsible for providing appropriate training, guidance, continuing education, and overall job competencies of direct reports.
- Establishes, maintains, and manages productivity and quality standards. Maintains, develops, and implements operating policies and procedures pertinent to areas of responsibility.
- Directs various personnel actions including, but not limited to, hiring, performance appraisals, promotions, transfers, and terminations.
- Completes (or contribute to the completion of) various financial forecasts, including cost center labor and non-labor expenses and productivity, month-end financial reporting, receivables performance, and any long-range strategic plans for the Department.
- Remains informed of all government, managed care/commercial and industry trends that impact revenue cycle operations Assists department director with assessments of internal controls, policies, and procedures to ensure compliance with appropriate federal, state, and regulatory entity guidelines and procedures.
- Monitors quality by performing audits (using departmental protocol and methodologies) of outputs and ensures all associated processes are followed consistently.
- Manages ongoing analysis, development, quality improvement and implementation of methods and systems to improve efficiency and effectiveness of pre-service financial clearance functions to the organization including:
- Provides project management/change management leadership and support as requested by the Director or Front-End Revenue Cycle.
- Manages all tasks associated with monitoring Pre-Services Financial Clearance core missions - processes patient services efficiently and effectively.
- Makes financially responsible decisions for assigned areas of responsibility in purchasing of office supplies and other department operations supply needs.
- Helps implement staffing model with little to no reliance on overtime hours.
- Ability to communicate effectively and in cooperation with management/departments within Stamford Health and with outside agencies, other hospitals, and professional organizations
- Provides weekly KPI outcomes reports to Director, Front-End Revenue Cycle on status of processes and pre-service functions and responsibilities.
- Participates in leadership meetings and projects to advocate positions that will help the Department and is in the best interest of the organization.
- Ability to troubleshoot current and anticipate potential problems and resolve by involving appropriate departments and personnel when needed and have the expertise to know when to involve others.
- Uses denials data to proactively re-engineer processes to avoid insurance eligibility, medical necessity, and authorization related denials.
- Performs other related duties incidental to the work described above as assigned.
Required Skills
EXPERIENCE: At least five years of revenue cycle experience required. Minimum 3 years of supervisory/management experience required. Previous experience at a manager level or above within a healthcare setting preferred. Prior experience in Pre-service, Pre-Access, Patient Access, or Patient Financial Services highly desirable.
EDUCATION : Bachelor’s degree required. Master’s degree in Business Administration, Healthcare Administration or relevant equivalent desirable.
Required Experience