Patient Access Operations Manager

2 weeks ago

Peoria, Arizona, United States NRGUSA Full time

Overview: The Patient Access Operations Manager plays a crucial role in facilitating and overseeing patient access to NRGUSA services. This position encompasses the management of the Patient Scheduling and Eligibility & Authorization Departments, ensuring a seamless experience for patients.

Key Responsibilities:

  • Lead and coordinate patient access operations, focusing on scheduling, eligibility verification, and insurance authorization processes.
  • Supervise teams of specialists in eligibility, authorization, and patient scheduling to enhance operational efficiency.
  • Collaborate with various departments to guarantee the timely and precise handling of eligibility and authorization requests.
  • Provide comprehensive training and ongoing support to staff regarding scheduling, eligibility, authorization, and billing protocols.
  • Analyze patient access metrics to identify trends and implement improvements.
  • Maintain meticulous records and documentation of eligibility and authorization processes, monitoring team performance through KPIs and reports.
  • Ensure effective scheduling of appointments and verification of patient benefits.
  • Utilize electronic verification tools and liaise with insurance providers to confirm patient eligibility and benefits.
  • Update patient insurance information in the practice management system as needed.
  • Obtain necessary referrals and authorizations for medical procedures and services.
  • Act as a liaison among patients, healthcare providers, and insurance companies to facilitate communication and information gathering.
  • Address issues related to rejected claims concerning patient eligibility or authorization.
  • Handle incoming inquiries from providers and insurance representatives regarding coverage.
  • Ensure all patient inquiries are addressed promptly and effectively.
  • Foster strong relationships with patients to ensure accurate and current demographic and insurance information.
  • Stay informed about clinical services and registration requirements across departments.
  • Maintain knowledge of healthcare regulations, including federal and state laws, OSHA, and HIPAA compliance.
  • Develop and implement strategies to enhance the eligibility and authorization workflow.
  • Perform additional duties as assigned.

Required Skills and Qualifications:

  • In-depth understanding of state and federal regulations related to eligibility and authorization.
  • Exceptional communication and interpersonal abilities.
  • Strong leadership and management capabilities.
  • Analytical skills to assess data and identify trends.
  • Excellent organizational skills with the ability to manage multiple tasks.
  • Ability to establish and maintain effective relationships with patients, insurance entities, and staff.
  • Proficient in written and verbal communication.
  • Experience with computerized billing systems, including practice management software and EMR.
  • Adherence to HIPAA regulations.
  • Knowledge of medical insurance and authorization processes.
  • Familiarity with medical terminology and experience in healthcare or insurance settings.
  • Understanding of organizational policies and procedures.

Education and Experience:

  • High School diploma or equivalent with a minimum of 5 years of relevant experience.
  • Bachelor's degree in healthcare administration or a related field is preferred.
  • At least 1 year of supervisory or management experience.
  • A minimum of 3 years of experience in patient scheduling, insurance verification, or related medical insurance programs.
  • Experience with eligibility verification and prior authorizations from various insurance providers.

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