Manager of Patient Access Services

POSITION SUMMARY:

The Provider Service Center Manager (PSCM) leads a team of supervisors and approximately 100 FTEs within BMC’s Patient Service Center and is responsible for coordinating all financial clearance activities. Under the supervision of BMC’s Patient Access Director, the PSCM is responsible for three functions within the financial clearance process: Pre-registration, coordinating PCP Referrals, and obtaining Authorizations. The PSCM  manages and coordinates resources and activities of teams to ensure department meets productivity and quality goals; performs trend analysis and produces managerial and executive level reports; identifies and resolves problems; collaborates with revenue cycle and clinic leadership  to ensure patient access to BMC services, reduce denials, and maximize revenue.

Position: Manager of Patient Access Services      

Department: Ambulatory

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

The PSCM is responsible for three man functions within the Financial Clearance process, including Pre-registration, Referrals and Authorizations. These responsibilities include determining eligibility, verification of benefits, referrals, procedure/medication prior authorizations, and collection activities. The PSCM will have a strong understanding of Revenue Cycle Patient Access functions and responsibilities. This also includes strict adherence to applicable compliance and regulatory policies, coordination of benefits across primary payers, and managing the people, processes and technology applicable to Revenue Cycle financial clearance activities.

• The PSCM is responsible for strong performance of pre-claim Revenue Cycle access functions associated with patient encounter activity within Boston Medical Center. Indicators of string performance include: High productivity and quality scores, maintaining volume throughput, lowering eligibility, referral, and authorization denials, and increasing cash. The role implements Patient Access Services operations processes, and provides system-wide oversight of services that facilitate patient access to outpatient services.
• Ensures that the teams maintain throughput and productivity standards for financially clearing encounters between 14 days and 24 hours before the clinic date to determine if each encounter has been properly processed and documented. Timing process varies depending upon encounter scheduling.
• Consistently manages all team activities so that timely and accurate registration, referral, authorization, and financial counseling referrals are provided to meeting all federal, state, and third-party payer guidelines and regulations.  Oversees activities to ensure department meets goals and objectives or suggests alternatives or adjustments as necessary.
• Acts as a resource for clinic staff regarding registration, insurance eligibility, authorizations, and documentation guidelines. Advises or refers providers to appropriate sources.
• Ensures proper training and education for department members. Develops training programs for Boston Medical Center employees related to certain Epic Registration and Insurance modules and activities.
• Serves in a strategic role in managing patient access revenue cycle operations. Responsibilities include program planning, operations monitoring, budget performance, and the continual evaluation of evolving staff, operations, and technology requirements.
• The position will coordinate with executive leadership to ensure that the planning and direction of comprehensive programs for revenue cycle access are aligned with Boston Medical Center’s strategic plan and work to appropriately integrate and facilitate best practices and achieve efficiencies while maintaining quality, compliance and service delivery standards.
• As a key leader in the revenue cycle operations, this role collaborates with the leadership of other revenue cycle departments as well as various clinic leaders within the ambulatory care and clinical services department to improve patient access systems, enhance scheduling and registration processes, minimize billing issues, prevent denials, increase cash, support compliance and meet all State and Federal Regulatory requirements.
• The Manager partners with leadership of IT, Ambulatory Administration, Human Resources, Marketing, Quality and other institutional departments to coordinate and maintain appropriate strategies and support.
• The Manager also interfaces with external entities such as State and Federal regulatory agencies, payer representatives, vendors, other Healthcare institutions, patients and families.
• Conducts Denial Analysis to understand and report on common themes for denials to determine whether goals are being met by the respective teams and the overall effectiveness of the unit.
• Demonstrates ability to implement problem-solving mechanisms in routine and emergency situations and to initiate and implement changes in systems and procedures as required.
• Responsible for effective fiscal management of departmental operations to ensure proper utilization of departmental financial resources.
• Involved in interviewing, hiring decisions and training/orientation for new and existing staff, when required.
• Communicate Payer relation changes to Financial Clearance Management Team.
• Uses hospital's Core Values as the basis for decision making and to facilitate the division's hospital mission.
• Follows established hospital infection control and safety procedures.
• Adheres to all of BMC’s RESPECT behavioral standards
• Performs any all other duties as assigned by BMC Directors or Revenue Cycle Senior Leadership

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

Bachelor’s degree preferred, or equivalent combination of education, training and experience is required.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

None

EXPERIENCE:

Three years progressive responsible managerial roles of which 2 years should be in healthcare/hospital revenue cycle management or related areas.

KNOWLEDGE AND SKILLS:

• Knowledge of detailed Patient Access and Ambulatory patient interface processes
• Knowledge of Revenue Cycle flow and the interdependence of systems that affect revenue cycle outcomes
• Strong leadership, organizational and collaboration skills
• Strong ability to speak to and drive operation key metrics
• Excellent oral and written cross disciplinary communication skills to all levels of the organization
• Strong experience in evaluating results of programs based on data analysis
• Specific knowledge in managing and improving the performance of complex operational systems and revenue cycle functions across multiple platforms
• Systems thinker with demonstrated ability to automate operations and functions to achieve a high level of work output, performance, and efficiency in a decentralized organization
• Understanding of cause and effect; strong problem solving and Analytic skills
• Effective collaborative and proven process skills.
• A strong working knowledge of Microsoft Office products.

Equal Opportunity Employer/Disabled/Veterans

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