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Director, Patient Administrative Services & Access

Company

Valley Medical Center
Address , Renton, 98055, Wa
Employment type FULL_TIME
Salary $125,213 - $209,106 a year
Expires 2023-07-21
Posted at 11 months ago
Job Description
  • Location:
  • City State: Renton, WA
  • Shift: Days
  • Job Title: Director, Patient Administrative Services & Access
  • Type: Full Time
  • Department: Financial Advocate
  • Hours:
  • Req: 2023-0422
  • Salary Range: Min $125,213 - Max $209,106/annual. DOE
  • FTE: 1


:

JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Director, Patient Administrative Services & Access

JOB OVERVIEW: The Director, Patient Administrative Services is responsible for administering, coordinating, and reviewing the performance of functions related to administrative and business functions across the organization to include pre-registration, scheduling, insurance eligibility and benefit verification, referral and authorization management, collection of payments for upcoming services, financial counseling services necessary to financially clear the patient's account prior to or at the time of inpatient and outpatient services and Emergency Department registration functions. This role is also responsible for addressing escalation, which includes on-call availability 24/7 outside core business hours estimated at one week every four weeks. This leader stays current to identify and implement new and emerging strategies to increase efficiency, improve processes, and enhance the patient experience. As part of achieving these goals, the Director, Patient Administrative Services identifies opportunities to work with leaders in other areas-including corporate compliance, clinical services, case management, and other revenue cycle areas to ensure regulatory compliance, increase care coordination and improve process efficiency between departments. This position directs, guides, and manages financial clearance and quality functions to help ensure they are performed efficiently throughout Revenue Cycle. This position is responsible for special projects and maintains and reports on the progress and results of these initiatives to the CFO as requested. As a member of the Revenue Cycle leadership team, the Director, Patient Administrative Services is a key promoter of leading practice revenue cycle processes and strives to meet and exceed the needs of its customers.
This role shall serve as a collaborator and subject matter expert. As such, they work in a professional manner, with a high level of patience, tolerance, and grace, with all departments throughout the organization. Understanding that there are an unlimited number of perspectives and motivations - all of which must be considered and respected. Work will be performed with an Equity, Diversity & Inclusion (EDI) lens check to be culturally sensitive.

DEPARTMENT (S): Patient Administrative Services: Patient Access / ED Patient Access / Financial Access / Interpreter Services

WORK HOURS: This leader is expected to be on campus at the hospital at least 3 days per week, Monday through Friday during business hours.
Work hours are as required to fulfill job responsibilities. This includes on-call availability outside core business hours (24X7). On call is every fourth week, 24/7 - call is shared with other patient access leaders, so call would be once every 4 weeks, barring any vacancies.

REPORTS TO: VP, Revenue Cycle

PREREQUISITES:

  • Bachelor's degree required. Five (5) or more years of relevant and applicable experience may substitute degree requirement (or a combination thereof).
  • Minimum of eight (8) years of experience in revenue cycle management in a complex healthcare environment including five (5) years of prior management experience, required.
  • Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook; Excel knowledge at an advanced level, preferred.
  • Minimum three (3) years EPIC experience in Patient Financial Services or Patient or Financial Access setting, required.
  • Demonstrates ability to communicate verbally, in writing and presentation form in the English language in an effective manner.
  • Proven analytical and critical thinking skills.

QUALIFICATIONS:

  • Demonstrated knowledge and understanding of financial clearance and quality functions for all functional areas, including Governmental and non-government payers.
  • Understands regulatory requirements in relationship to Payor requirements.
  • Comprehensive knowledge of industry standards.
  • Demonstrates adaptability and flexibility with shared knowledge while being receptive to differing views and ideas.
  • Demonstrated familiarity, knowledge and understanding of relevant hospital and clinic policies, practices, and HIPAA regulations.
  • Demonstrated ability to develop collaborative relationships with Physicians, Administrators, and Management staff.
  • Demonstrates excellent organizational and interpersonal skills, including the ability to work collaboratively across departments, internal and external to Valley, as a team member or leader in a matrix environment with colleagues at all levels of the organization to achieve strategic goals.
  • Demonstrated analytical, problem-solving abilities, strong organization and decision-making abilities with data, people, and situations.
  • Demonstrated business communication skills including communicating well with patients. Written, facilitating, interpersonal and professionalism at all employee and management levels.
  • Receiving, disseminating information effectively and appropriately, reviewing and acknowledging departmental communications.
  • Work independently with strong follow-up skills to ensure effective and efficient completion of tasks.
  • Ability to manage multiple projects in a timely and efficient manner.
  • Ability to set priorities, produce accurate work and process all work tasks in a timely, comprehensive manner.
  • Self-motivated and results oriented.
  • Successful team leadership and development.
  • Understands the relationship between operational effectiveness, corporate strategy, customer satisfaction, and acts accordingly when addressing concerns or opportunities.
  • Understands multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to maximize reimbursement and minimize financial risk.
  • Ability to remove technical and cultural barriers to achieve operational objectives.
  • Possesses a combination of technical skills, people skills, political acumen, and strategic innovation.
  • Ability to function in a setting with a wide variety of duties and numerous interruptions.
  • Knowledge and skill set in process improvement.
  • Neat, well-groomed, professional appearance.

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS:

  • Must possess ability to work independently, with a minimum of direction, and take initiative in problem solving.
  • Must be able to interact professionally and effectively with a wide variety of people, including operations staff, providers, the public, and departments at Valley Medical Center (VMC).
  • Attention to detail and excellent organizational skills are essential.
  • Must be able to function effectively in an environment with frequent interruptions and multiple tasks.
  • Must be able to effectively interact with patient access and billing systems and other relevant third-party software, create and maintain spreadsheets, and take and compose meeting minutes.
  • Requires manual and finger dexterity as well as vision corrected to normal range.

PERFORMANCE RESPONSIBILITIES:

  • Generic Job Functions: See Generic for Director.
  • Essential Responsibilities and Competencies:
  • Overall responsibility for timely and accurate patient administrative and business functions across the organization.
  • Overall responsibility for data quality and timeliness relating to pre-registration and registrations for all elective cases, surgeries, ancillary and emergency department visits.
  • Overall responsibility of front-end data quality for coverage assignment, payer authorization (inpatient and outpatient), communicating to patients the financial expectations of the hospital and financial counseling activities.
  • Oversees that registration accuracy and other activities assigned to Patient Administrative Services department(s), ensuring patient satisfaction is prioritized.
  • Monitors reports to help ensure allowable co-pays, deductible, and coinsurance amounts are identified and collected prior to, or at the point of service, while utilizing patient estimate tool to maximize estimate accuracy for patients.
  • Works collaboratively with other departments to help ensure the processes and systems for Patient Administrative Services are standardized and optimized for efficient and effective flow of patients within the department and organization.
  • Serves as a resource to Administrators, providers, managers, and clinic staff in all financial clearance related issues.
  • Reinforces compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed, (i.e.) Medicare Secondary Payer, authorization for inpatient and outpatient services, and verification of eligibility or other primary coverage.
  • Demonstrates awareness and compliance with all applicable laws, regulations, guidelines, and professional standards at the federal, state, and agency level.
  • Monitors AR on a regular basis with a focus on work queue monitoring and denial reporting mechanisms to assure that all activity is managed timely and denial prevention opportunities are continuously evaluated.
  • Works with Revenue Cycle management to identify denial trends; supports implementation of process improvements to reduce denials and or delays in billing relating to departmental areas.
  • Meets with direct reports at least twice weekly, Supervisors bi-weekly (unless the Manager is out, then twice weekly). Holds an all staff meeting quarterly via zoom.
  • Rounds to keep staff informed of process changes and to observe their competency and performance. Meeting / Rounding with direct reports weekly or bi-weekly as needed, and other management monthly. Rounding with one-third of the staff each 4-month period to result in three rounding sessions per staff member, per year at the staff/front line level.
  • Manages relationships with vendors that provide services to support the Patient Administrative Services department. Reviews and audits their invoices that require Director level approval to assure compliance with the contract and accuracy of the invoice.
  • Sets and monitors performance assessment criteria, including productivity and quality measures; utilizes dashboards/reports for Patient Administrative Services areas.
  • Reviews staff performance reports and works with Revenue Cycle leadership to develop remediation strategies and set goals; For those staff with poor performance, is involved personally, meeting with the employee and their direct supervisor at kickoff of a performance improvement plan and regular intervals thereafter until issues are resolved, providing resources, and working to seek performance improvement.
  • Addresses staff concerns in a manner that assures consistency and promotes employee engagement and satisfaction.
  • Conducts regular performance reviews and promotes ongoing communication regarding performance and process related issues and provides input on the performance reviews of all employees in the department at all levels that can be visible to the employee.
  • Communicates initiative status, accomplishments, key issues, and risks to leadership on a regular basis, while identifying issues requiring resolution.
  • Monitor workflows with a focus on continuous process improvement; measurement and management of cross-functional performance.
  • Collaborates with departments across the organization to develop improvement initiatives aimed at achieving organizational goals.
  • Partners with IT to identify and optimize benefits and functionality of host system.
  • Manages process improvement initiatives; monitors team adherence to established standards for documentation of project deliverables, issue management, decision logging, action item management, project planning, scope management, budget management and resource tracking.
  • Achieves operational objectives by contributing information and recommendations to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, and customer-service standards; resolving problems; completing audits; identifying trends; determining system improvements; implementing change within agreed upon timelines.
  • Demonstrates awareness of the importance of cost containment for the department. Responsible for developing, implementing, and overseeing process or quality improvement solutions.
  • Controls costs by managing the overall budget, monitoring savings objectives, reviewing financial analysis of all initiatives, and investigating variances in expenses or usage.
  • Demonstrates leadership abilities, to include determining appropriate staffing levels, recruitment, hiring and retention practices, developing and conducting disciplinary procedures and performance improvement plans as needed.
  • Oversees the education & training programs across all areas of responsibility, including new hire orientation, competency assessments, remedial education, and ongoing education.
  • Establishes and/or revises policies and procedures while focusing on continuous improvement and ensuring compliance with government regulations and corporate policies. Reviews policies at least once per year and obtains buy-in of stakeholders affected by those policies.
  • Assures emergency and safety procedures are reviewed at least yearly and are available if needed; including documenting, tracking, and managing safety events.
  • Reviews and recommends changes that pertain to the functions of the department including Patient Administrative Policy, Emergency Preparedness & other online manuals are maintained and updated.
  • Performs outreach and collaborates with healthcare peers to identify industry best practices and strategies to remain competitive, especially at the local level, and communicates those findings and trends to their leader as applicable.
  • Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations and keeping up to date on the skills required to perform the major functions of the department.
  • Create continuing education program content at least annually for all Patient Administrative staff, assuring the team has access to the most up to date information relevant to their job functions.
  • Create a program to ensure employees looking to advance their careers feel supported and have opportunities to gain experience.
  • Oversees the contract negotiations for the interpreter services program to ensure we provide reliable cost-effective resources to our patients and staff.
  • Maintains continuing education for awareness of impacts of regulatory agency requirements as to their effect on the financial viability and/or compliance of the organization.
  • Assures education regarding regulatory standards for all areas of responsibility. Oversees performance of all functions for compliance with Federal and State requirements.
  • Maintains confidentiality of all protected health information.
  • Provides backfill for teams as required. Short staffing, patient surges, disasters and more may require Director coverage for front line workers to address the current patient need.
  • Provides coverage / backup to Managers and Supervisors when out on leave or positions become vacant. See applicable job descriptions for specific duties.
  • Represents Patient Administrative functions (e.g., Access and Financial Clearance) in the Management Team Meetings, Leadership Development institute (LDI), Daily Safety Briefing (DSB) and other leadership settings.
  • Follows the Mission, Vision, and Values of Valley Medical Center. Performs all job functions in a manner consistent with Valley's cultural expectations defined as Valley Values. These characteristics include quality performance, demonstrating compassion, respect, teamwork, community-centered awareness, and innovation.
  • Complete additional projects and duties as assigned.

Date Created: 3/23

Revised: 4/23

Grade: NC32

FLSA: E

Cost Center(s): 8485 / 8560 / 8561 / 8562


Job Qualifications:

PREREQUISITES:

  • Bachelor's degree required. Five (5) or more years of relevant and applicable experience may substitute degree requirement (or a combination thereof).
  • Minimum of eight (8) years of experience in revenue cycle management in a complex healthcare environment including five (5) years of prior management experience, required.
  • Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook; Excel knowledge at an advanced level, preferred.
  • Minimum three (3) years EPIC experience in Patient Financial Services or Patient or Financial Access setting, required.
  • Demonstrates ability to communicate verbally, in writing and presentation form in the English language in an effective manner.
  • Proven analytical and critical thinking skills.

QUALIFICATIONS:

  • Demonstrated knowledge and understanding of financial clearance and quality functions for all functional areas, including Governmental and non-government payers.
  • Understands regulatory requirements in relationship to Payor requirements.
  • Comprehensive knowledge of industry standards.
  • Demonstrates adaptability and flexibility with shared knowledge while being receptive to differing views and ideas.
  • Demonstrated familiarity, knowledge and understanding of relevant hospital and clinic policies, practices, and HIPAA regulations.
  • Demonstrated ability to develop collaborative relationships with Physicians, Administrators, and Management staff.
  • Demonstrates excellent organizational and interpersonal skills, including the ability to work collaboratively across departments, internal and external to Valley, as a team member or leader in a matrix environment with colleagues at all levels of the organization to achieve strategic goals.
  • Demonstrated analytical, problem-solving abilities, strong organization and decision-making abilities with data, people, and situations.
  • Demonstrated business communication skills including communicating well with patients. Written, facilitating, interpersonal and professionalism at all employee and management levels.
  • Receiving, disseminating information effectively and appropriately, reviewing and acknowledging departmental communications.
  • Work independently with strong follow-up skills to ensure effective and efficient completion of tasks.
  • Ability to manage multiple projects in a timely and efficient manner.
  • Ability to set priorities, produce accurate work and process all work tasks in a timely, comprehensive manner.
  • Self-motivated and results oriented.
  • Successful team leadership and development.
  • Understands the relationship between operational effectiveness, corporate strategy, customer satisfaction, and acts accordingly when addressing concerns or opportunities.
  • Understands multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to maximize reimbursement and minimize financial risk.
  • Ability to remove technical and cultural barriers to achieve operational objectives.
  • Possesses a combination of technical skills, people skills, political acumen, and strategic innovation.
  • Ability to function in a setting with a wide variety of duties and numerous interruptions.
  • Knowledge and skill set in process improvement.
  • Neat, well-groomed, professional appearance.