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Dir Patient Access Services PSO

Wellstar Shared Services • Marietta, GA • Leadership • 111646 • Days • Full-Time

Overview

Under the direction of the Executive Director of Patient Access Services (ED, PAS) the Pre-Service Operations (PSO) Director organizes, monitors and maintains the daily operational functions of centralized and decentralized Pre-Service functions include scheduling, insurance verification, prior authorization and pre-registration. The oversight of the PSO Director includes, but is not limited to, the supervising of managers, supervisors, and their employees, coordinating performance improvement activities, and productivity management. Ensures adherence to policies and procedures, improvement in employee engagement, quality and excellence of work performed, world class customer service, and continual staff education.

The PSO Director will continually monitor Key Performance Indicators as established for PreService related functions to ensure all service areas reporting through the Revenue Cycle PAS is meeting or exceeding each goal. Additionally, measures non-traditional PAS points of entry and includes results with monthly metrics to the Exeutive Director and AVP Patient Access Services. When goals are not met, the Director is responsible for developing corrective action plans and communicating them to the Executive Director; recommendations for non traditional PAS locations are also provided to the ED for escalation purposes. The PSO Director is responsible for development of the annual operating and capital plans. The PSO Director is responsible for maintaining positive working relationships with key PAS, Facility and Executive Leaders. Demonstrates professionalism, effective communication skills and active listening skills.

Responsibilities

Core Responsibilites and Essential Functions

  • Results-Oriented Leadership of Assigned Patient Access Service Area(s)
    * Oversee assigned facility operations of Patient Access functions (e.g. pre-registration, benefit verification, pre-authorization, admission/registration, service pre-payment, etc.) to ensure daily operations are maintained according to the expectations and standards while in a manner compliant with regulatory requirements, Facility specific requirements and WellStar Health System Policies and Procedures.
    * Model AIDET guidelines in all interactions with the patient and ensure staff are adhering to the patient experience expectations.
    * Implement and promote excellent customer service
    * Serve as the primary liaison between the WES and the Facility
    * Maintain and promote good customer relations with facility-based leadership, physicians and physician office staff.
    * Review Patient Access performance to ensure timeliness, accuracy, compliance and standards fulfillment as defined by WES.
    * Inform the Executive Director and/or AVP of PAS and any key stakeholders of any significant issues in the Patient Access area (e.g., Pre- registration delays, pre-authorization backlogs, etc.)
    * Perform other duties as assigned
  • Leadership of Daily Operations of Assigned Patient Access Service Area(s):
    * Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education Inform staff of relevant changes and developments in payer requirements
    * Ensure quality review measurements are in place and performed in accordance with policy or need based guidance.
    * Facilitate implementation and monitoring of standard master files, processes, reporting and education programs.
    * Follow Functional Standard Guidelines and Best Practice Suggestions.
    * Oversee management of Patient Access personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action where appropriate,
    * Develop specific objectives, budgets, and performance standards for each area of responsibility,
    * Identify and implement process improvements to lower costs and improve services to facility customers
    * Perform rounding to ensure staff are following Patient Experience Expectations
    * Develop goals and objectives for the Patient Access Services department, consistent with internal and external benchmarks, in support of WellStar Health System policy and goals, including quality outcomes and consistent application of standards and performance measures for all registration related functions performed by WellStar Health System departments
    * Maintain and review written policies, initiates change in or develop new policies, procedures and/or methods as needed to meet department and institutional objectives.
    * Work closely with the 'WellStar Connect' team on the design and implementation of processes, procedures and programs to streamline workflow, improve staff productivity and enhance quality of data collection, while maximizing clinical and financial outcomes, patient satisfaction, physician satisfaction.
    * Engages staff in the development, monitoring and achievement of department goals and ensures the effective operations of the Patient Access Services department through program development, process improvement and coordination/integration of processes with other departments.
    * Facilitates intra-department coordination, standardization and outcome targets for key access processes including: scheduling, data collection, insurance verification, authorization, registration, patient estimation of service and financial liability, admitting and bed control (Note: bed control is applicable where the activity is a function of the facility specific PAS department responsibility only).
    * Coordinates with outpatient clinics and ancillary services, physician practices, referral hospitals, community and public agencies, and WellStar Health Systems bed control staff to streamline patient access procedures.
    * Works with executive leadership, clinical directors, and physicians to identify capacity issues that create barriers to patient flow into the WellStar Health System
    * Is knowledgeable and proficient in the administration and departmental compliance of State and Federal rules and regulations for assigned areas, and ensures that staff are properly trained and knowledgeable of these rules and regulations and that they carry out their duties with compliance to these rules and regulations, such as the Advanced Beneficiary Notification (ABN), Medicare as a Secondary Payer (MSP), Advanced Directives, Patient Bill of Rights, patient privacy, medical necessity, observation status and other regulatory guidelines.
    * Responsibility for compliance and performance of management related HR functions for the department which includes interviewing, hiring and orienting staff in collaboration with managers. Responsible for team building across departments.
    * Responsibility for compliance and performance of management completion of performance evaluations in a timely manner.
    * Accountable for time keeping for teams and for responsible for managing schedules/time and attendance.
    * Responsibility for the performance of management related functions such as meetings with direct reports and supporting individual developmental goals.
    * Implementing new or revised programs of the department, Facility or WES.
    * Ensure the effective Patient Intake (Including but not limited to: Patient Scheduling, Medical Necessity Review, and Medical Orders Management)
    * Where assigned, ensure Pre-Service Screening is being performed on all patients (Pre-Registration, Insurance Eligibility / Benefit Verification, Pre-Certification / Authorization, Patient Liability Estimation, Pre-Service Collections and Financial Counseling Referral)
  • Budget/Financial- Responsible for assisting in the development and monitoring of the facility PAS budgets and in the financial contribution of all supervised departments.
    * Develops and monitors the departmental budget. Ensures monthly variance reports are accurate and thorough.
    * Responsible for monitoring and maintaining collections at time of service at acceptable levels.
    * Collaborates effectively with other department Leaders to maximize cash flow and minimize wait times.
    * Conducts focus initiatives on or around productivity, streamlining operations and reducing error rates.
    * Manages resources and supplies efficiently in order to administer cost effective services.
    * Resolves errors and applicable Claim, DNB and Patient WorkQueues.
    * Recommends sufficient number of qualified/competent staff.
    * Actively seeks ways to control costs without compromising patient safety, quality of care of the services delivered.
    * PAS Revenue Optimization includes specific actions that are related to: POS Collections Improvement, Disputed Claims Reduction, Pre-Bill Holds / DNFB / CFB Reduction; Payer ? Provider Collaboration; Compliance Integrity; and Vendor Relations.
    * Physician Liaison when necessary (Related to Patient Scheduling, Financial Clearance and Denial Management activities)
    * Provides facility level oversight for improvement programs and initiatives: to ensure clinical and patient experience compliance, drives increase in POS collections, reduction in DNFB, reduction in mail returns, reduction in avoidable write-offs, increase in financial clearance rates, and other initiatives designed to improve financial and customer services outcomes.
  • Leads the planning, organizing, prioritizing and management of Patient Access Service operations:
    * Participate and/or present in pertinent facility meetings/committees
    * Determines staff qualifications and competence. Develops and maintains accurate initial and annual competency checklists, and initiates completion of initial and annual competency attestation forms.
    * Attends in-service presentations, and complete mandatory education including, but not limited to, infection control, patient safety, quality improvements, MSDS and OSHA Standards.
    * Demonstrates knowledge of occurrence reporting system and utilizes system to report potential patient safety issues.
    * Understands and can communicate the functions and purpose of all Revenue Cycle division.
    * Monitors and ensures maintenance of accounts, DNB/Denials, claim, patient, and other related Work-Queues that impact the Revenue Cycle.
    * Coordinates monthly Denial resolution for respective facility.
    * Ensures quality and drives resolution of safety initiatives which impact the overall health of WellStar Health System.
    * Monitors processes to adhere to any regulatory requirements set by state, federal and/or governing bodies.
    * Collaborates with Revenue Cycle Leaders to develop and implement goals, objectives and Action Plans for the department.
    * Represents the department at various WHS meetings and functions.
    * Participates in special projects. Assumes accountability.
    * Responsible for the ongoing management of daily operational functions of the department.
    * Coordinates and completes the overseeing employee performance reviews and annual evaluations.
    * Works closely with management team in the hiring, counseling, dismissals, promotions and transfer of employees.
    * Mentors and coaches the team in order to promote effective and productive leadership within the department and culture of accountability.
    * Monitors performance management that counseling is consistently given for non?compliance with WellStar Health System policies and procedures.
    * Maintains Management files.
    * Ensures appropriate participation and management of area and department involvement in performance improvement projects.
    * Analyzes results of PI projects and implements changes for improvement.
    * Collaborates with direct reports to implement and complete appropriate PI projects in support of WellStar Health System vision and mission.
    * Facilitates intra-department coordination, standardization and outcome targets for key access processes including scheduling, data collection, insurance verification, authorization and registration.
    * Coordinates with outpatient clinics and ancillary services, physician practices, referral hospitals, community and public agencies, and WellStar Health System departments to streamline patient access procedures.
    * Respects and maintains the privacy of patient?s personal/protected health information.
    * Adheres to and educates staff about the importance of HIPAA and patients personal health information.

  • Required for All Jobs

  • Performs other duties as assigned
  • Complies with all WellStar Health System policies, standards of work, and code of conduct.

  • Qualifications

    Required Minimum Education

  • Bachelor's Degree in business, healthcare or related field Required and
  • Master's Degree Preferred

  • Required Minimum Experience

  • Minimum 7 years experience in managing hospital admissions, business office or related area. Required and
  • Proven performance improvement and change management experience. Required and
  • Minimum 5 years of management experience Required and
  • Epic experience Preferred

  • Required Minimum Skills

  • Strong interpersonal, analytical, problem solving and writing skills, with a ?take charge? attitude.
  • Must be comfortable interacting with department directors and administrators and able to perform a wide variety of tasks that require independent judgement, ingenuity, and initiative.
  • Effective communication skills (both written and verbal), attention to detail, self-directed and a positive attitude are essential.
  • Effective problem solving and critical thinking skills.
  • Working knowledge of patient registration systems and proficiency with Microsoft Office Suite are essential.

  • Required Minimum License(s) and Certification(s)

  • Cert Healthcare Access Assoc 1.00 Required 1.00
  • Cert Healthcare Access Mgr 1.00 Required 1.00
  • Cert Healthcare Financial Prof 1.00 Required 1.00
  • Certified Patient Account Rep 1.00 Required 1.00
  • Certified Revenue Cycle Rep 1.00 Required 1.00

  • Additional Licenses and Certifications

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