Manager, Financial Clearance

1 month ago

Barnstable, United States Cape Cod Healthcare Full time

PURPOSE OF POSITION:

Provides leadership and oversees daily Financial Clearance operations within the Patient Access (“PAS”) department, including the employed physician group. Supports Director of Patient Access to execute the strategic vision for system-wide PAS and Financial Clearance functions. Confirms supervisors are consistently performing productivity and quality assessments and staff are being supported in their efforts to improve their performance. Ensures that financial clearance requirements are consistently met. Functional areas that report to this position include Financial Clearance and Central Referral/Authorization


PRIMARY DUTIES AND RESPONSIBILITIES:

  • Support, oversee, and manage the performance and productivity of the team as it relates to financial clearance activities and pre-defined goals/targets, while providing feedback and guidance to supervisors and the team.
  • Develop, implement, and manage efficient and effective operational policies, procedures, processes, and performance monitoring for Financial Clearance.
  • Define, implement, and monitor strategies to improve overall Financial Clearance.
  • Confirms supervisory staff are consistently performing performance-monitoring processes.
  • Manage the team’s ability to perform follow-up activities with patient and/or referring physician office in the event of failed eligibility, lack of valid authorization/referral or lack of patient benefits for scheduled service.
  • Manage to applicable PAS Key Performance Indicators (“KPIs”). Define and implement action plans when performance is not meeting expectations.
  • Recommend new approaches to enhance and improve productivity as needed.
  • Support Director of Hospital Patient Access to execute strategic vision for PAS and implement changes needed to comply with payer and regulatory requirements.
  • Assess direct reports’ performance on a consistent basis and provides feedback to reward effective performance and enable proactive performance improvement steps to be taken.
  • Maintain up-to-date knowledge of regulatory and compliance changes impacting area of responsibility and ensure employees are appropriately educated and processes are modified as needed.
  • Assess workflow prioritization daily to confirm that metrics and benchmarks are consistently achieved.
  • Collaborate with other disciplines to implement changes as needed to Financial Clearance.
  • Develops and delivers organized, thorough communication to management, Sr. Leadership, and other departments regarding proposed changes, deficiencies, developments, and opportunities affecting the organization.
  • Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers.
  • Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.


EDUCATION/EXPERIENCE/TRAINING:

  • Bachelor’s degree required or equivalent combination of education and experience. Master’s degree preferred.
  • Required three to five years of experience in patient access financial clearance operations with at least two years in a supervisory capacity.
  • Experience and knowledge of third-party reimbursement and eligibility processes and regulations.
  • Ability to evaluate personal performance against established goals.
  • Demonstrated goal-oriented thinking, operational and organizational skills.
  • An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
  • Excellent communication, leadership, delegation, and interpersonal skills.
  • Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines.
  • Ability to communicate with and present to a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.

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