Director, Patient Access Services - Admitting - Chula Vista/Coronado - Full Time
- Bachelor's Degree in Business or HealthCare.
- 10 Years Progressive revenue cycle management in an integrated healthcare environment with experience in all phases of hospital revenue cycle.
- 10 Years Technical experience working with ADT/AR, EHR, coding and ancillary systems.
- Master's Degree
- Works closely with Revenue Cycle System Directors and hospital Senior leadership to collaborate on advancing strategic direction and represents Access and Revenue Cycle in matters related to the operational performance of Patient Access.
- Is responsible for one or more major functions or implementations at all PAS departments for all hospitals, as assigned. Examples include, but are not limit to: EPIC implementation, regulatory compliance, productivity standards, analytics and KPI’s, quality control, auditing, and compliance.
- Provides leadership to a variety of system projects and initiatives that impact the revenue cycle. This includes leading and participating on workgroups for centralized bed placement, Price Transparency, Good Faith Estimates, No Surprises Act, ADT/AR upgrades, EDI transaction development, and implementation of insurance eligibility and payer notification processes. Supports initiatives of clinical documentation improvement and medical necessity status determination and alignment between physician order/accommodation code/claim payment request.
- Ensures the optimal and standardized use of front-end solutions for Patient Access Services to produce a zero-defect and fully compliant claim within 3days of discharge. Front-end solutions currently in use include hold bills/alerts, integrated electronic eligibility, financial status/application referral evaluation and reporting.
- Leads standardizing, creating, and sustaining a common culture and high performing operations. Motivates, facilitates, mentors, and coaches Patient Access teams to deliver high-quality, cost-effective services. Enforces a spirit of continuous performance and process improvement.
- Serves on community forums and tasks forces representing the hospital system in the arena of public access and community needs. Develops tools necessary for transition to Health Benefit Exchanges, providing unfunded patients with appropriate and timely information regarding their financial obligation.
- Collaborates with hospital/system peers and staff to increase operational excellence, decrease risk (financial or clinical), and promptly address operational needs surrounding workflow, policy and procedures.
- Collaborates on education and communication related to system initiatives to support user adoption and accuracy. Includes clinical and ancillary department education related to charging and coding. Works closely with Case Management to redesign the process for concurrent review and authorization documentation. Consider technology alternatives and contract language that protect the hospital from concurrent review denials.
- Collaborates with interdisciplinary teams including but not limited to Physicians, Nurse Practitioners and Physician Assistants, Physician Informaticists, Clinical Informaticists, Quality, Case Management, Health Information Management, Revenue Cycle, and Finance to provide data and solution development. Promotes a strong collaborative working relationship across all teams.
- In conjunction with clinical, technical and revenue cycle leadership, sets short and long term goals for strategic progress towards success across the Sharp Pillars of Excellence. Makes decisions for accomplishment of objectives using data including: EHR, revenue cycle; expense management; employee, and physician satisfaction.
- Develops a thorough and proactive understanding of systems, processes, regulatory requirements, compliance exposure, and payer specific authorization requirements contributing to the proactive identification of opportunities for revenue cycle improvement and enhancement.
- Able to professionally respond, both orally and in writing, to physician, executive, patient and employee requests/complaints/queries.
- Extensive knowledge of billing compliance and regulatory requirements for Title XXII, JCAHO, CMS, HCAI.
- Extensive knowledge of regulatory requirements impacted by Access and Financial Service staff including, but not limited to Medicare Conditions of Participation, HIPAA, PHI, Fair Pricing, No Surprises, Price Transparency and EMTALA.
- Extensive knowledge of patient accounting systems, admitting and registration processes, and billing and collection processes.
- Understanding of processes and risks of combining/merging patient records and identities.
- Able to develop and manage to department budgets.
- Able to draft and execute department strategic plans.
- Familiar with ICD10 and CAC (Computerized Assisted Coding).
- Understanding of both Business and Clinical processes affecting Revenue Cycle and Patient Satisfaction.
- Case Management background beneficial.
- Good understanding of financial and analytic technologies and/or systems.
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