The posting
POSITION SUMMARY This position leads a team, or teams, within the Revenue Cycle organization that coordinates and facilitates financial clearing patients prior to surgery including building estimates, taking patient phone calls, following up on authorizations and collecting funds prior to service.
ESSENTIAL FUNCTIONS
Confirm valid coverage for services and location by contacting insurance companies and/or review electronic responses for benefit information. Manage patient insurance demographic information to verify authorization obligations. Verify that service is a covered benefit, based on knowledge of the specific insurance plan, the specific benefit package restrictions, and the timing of the service. Understand patient deductibles, out-of-network referrals and out-of-pocket limitations. Review the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information. Calculate and collect patient liability before or at the time of service. Communicate the liability and explain the calculation low and high amounts when necessary. Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately. Oversee and lead the assigned team to deliver on their goals and work to remove barriers to the team’s success. Reviews and approves employee time at and away from work to ensure proper coverage. Works with Revenue Cycle leadership to determine the appropriate team goals to meet the business needs and directs the execution of the billing workflow to hit the agreed upon targets. Provides training and skill assessment for billing team members including the development and delivery of a periodic Quality Assurance plan. Assists team members with their professional development in support of Atlas business goals. Develops the appropriate training and onboarding of new employees. Participates in the recruiting and assessing candidates for the Financial Clearance team as opportunities arise. Provide guidance and support to all Atlas parties to improve overall performance including the financial clearance days out, point of service collections and clean claim rate. Exhibits an interest in technology, automation and data driven solutions to the team’s business challenges. May work payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment to help the team meet goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing. Builds strong working relationships with assigned business units, departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients. Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors and Revenue Cycle stakeholders accurately. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
NOTE: The essential functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.
MINIMUM QUALIFICATIONS
Bachelor’s Degree or seven years of healthcare insurance and patient accounts experience. Requires knowledge of patient financial services, financial, collecting services, or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required. Bilingual (English/Spanish) may be required based on market(s) assignment. Must be able to speak, read, and communicate fluently in Spanish to support patient financial counseling, benefit explanation, and pre service communication.
PREFERRED QUALIFICATIONS
Work experience with HST Pathways, Mnet, and Waystar systems is preferred. Additional related education and/or experience preferred. Professional Certification through HFMA or AAHAM preferred. Focus on creating and maintaining procedures that align with a high standard of compliance and internal control. Working knowledge of patient accounting and experience reconciling AR accounts Excellent communication skills, written and verbal.
SUPERVISORY RESPONSIBILITIES
Includes direct supervisory responsibility for assigned department staff, including patient access representatives.
DIRECTLY REPORTING
Reports to the Manager – Patient Access
TYPE OF SUPERVISORY RESPONSIBILITIES
This position has managerial scope and oversight for employment actions, including coaching, candidate selection, training and development, performance appraisals, work assignments, and disciplinary action. Leadership will strive to uphold the mission, vision, and values of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.
SCOPE AND COMPLEXITY
Works independently under regular supervision and follows structured work routines. Works in a fast-paced, multi-task environment with high volume and immediacy needs requiring independent decision-making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient’s care. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided. Primary external customers include patients and their families, physician office staff, and third-party payors.
