Pre-Services Manager
5 days ago
The Pre-Services Manager is responsible for overseeing all functions of the patient pre services operations and staff to ensure patient safety and satisfaction as it relates to patient navigation and optimization of the organization’s financial performance. The main functions of oversite include patient pre-registration, insurance verification and enrollment, prior authorization, and financial counseling according to Noble Community Clinics policies, protocols, and practices. This role will have direct supervision over the Pre-Services Specialists and Patient Services Navigator teams. This role is ultimately responsible to ensure financial clearance of each account as well as financial counseling and enrollment practices are completed with every patient.
- Responsible for oversite of all areas of Pre-Services departmental functions including insurance verification, Medicaid and Marketplace enrollments, Social Determinants of Health, prior authorization, point-of-service cash collection, and financial counseling performed at all locations.
- Serves as a point of contact for coverage issues related to insurance, Medicaid, Medicare, sliding fee program, Marketplace enrollment, and community resources available to patients the Patient Services Navigators.
- Remains current on any changes with CMS updates and engages appropriate parties to ensure NCC is compliant with CMS regulations and Marketplace enrollment updates.
- Develops and implements efficient standard processes to ensure patient accounts are secured prior to the patient visit so accurate and timely billing and claim payment can occur in the Revenue Cycle.
- Directly supervises Pre-Services Specialists and Patient Services Navigators in accordance with the organization’s policies and applicable laws including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance and competency assessment; recognition and employee relations.
- Analyzes trends impacting marketplace enrollment, denials, upfront collections, and FQHC requirements for sliding fee scales and takes appropriate action to meet key performance indicators.
- Responsible for providing resourcing, training, and support for all pre-registration, financial clearance, and navigation activities completed on behalf of the organization.
- Responsible for handling patient and customer complaints related to Pre-Services in a professional and timely manner.
- Ensure adequate staffing is in place each day in the Pre-Services department, including developing and monitoring employee daily staffing schedules.
- Responsible for the accuracy and approval of employee timecards that includes approving PTO requests based on employee accrued time and business needs, and approving overtime when necessary.
- Expected to work collaboratively and professionally with other leaders to develop and maintain efficient and effective processes to ensure a positive patient experience.
- Responsible for generating and submitting required management reports as requested.
- Responsible for ensuring departmental metrics are met or exceeded for optimal operational performance of both Pre-Services and Revenue Cycle operations.
- Expected to continually pursue process improvement opportunities by analyzing, developing, and implementing practice policies, protocols, and workflows as needed.
- Responsible for managing the department within the established budget as well as assisting the Revenue Cycle Director with identifying departmental needs for annual budgeting processes.
- Serves as an OCHIN EPIC super user on pre-registration, financial clearance, and enabling services activities.
- Serves as point of contact and trainer on software applications used within the Pre-Services department.
- Conducts daily huddles and monthly department meetings with support staff to ensure employees have the training, support and resources need to perform their job duties efficiently and accurately.
- Must maintain regular and reliable attendance record and adhere to NCC policies.
- Frequent travel to clinic locations is required.
Education/Experience Requirements
Minimum High School diploma or equivalent required. Associate or bachelor’s degree in related field of study strongly degree preferred. Previous supervisory experience required. Previous experience working in health care setting with knowledge of financial clearance including insurance verification, prior authorization, denials prevention and securing patient accounts strongly preferred. Will consider previous management experience in healthcare financial clearance in lieu of a degree. Must be a Certified Application Counselor (CAC) or complete CAC certification within one year of hire.
Noble Community Clinics is proud to be an Equal Opportunity Affirmative Action employer.
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