JOB SUMMARY AND SCOPE
The Patient Access Manager is responsible for ensuring that all activities and data capture within the patient access service areas are properly recorded, coordinated, monitored, tracked, and resolved in support of the Revenue Cycle Life Cycle.
MINIMUM REQUIREMENTS
Associate’s degree in a business-related field or equivalent experience
• Minimum of 2-3 years’ experience in a healthcare setting, with experience in patient access, scheduling or registration.
• Prior management or supervisory experience
• Working knowledge of medical terminology & health insurance plans.
• Strong computer skills, including electronic medical records (EMR) systems.
• Ability to work independently as well as a team setting, performing under pressure, and with periods of interruption
• Excellent communication and organizational skills
ESSENTIAL JOB FUNCTIONS
- Coordinates and manages patient access to healthcare services, including scheduling appointments, referral management, verifying insurance coverage, and managing patient registrations.
- Oversees all organizational patient access service points within the hospital and clinics and provides training as needed.
- Establishes and manages patient flow and ensures that patients are seen promptly and efficiently.
- Ensures the appropriate staffing of Patient Access and O/P scheduling.
- Directs and supervises all patient access and outpatient scheduling staff .
- Communicating with patients, families, and healthcare providers to provide information and ensure patients receive the appropriate care and treatment.
- Verifies insurance coverage and obtains pre-authorization for procedures and treatments, as needed.
- Works with billing and insurance teams to ensure that claims are processed correctly and on time.
- Manage patient data and maintain accurate and up-to-date patient records.
- Resolves patient complaints and concerns in a timely and professional manner.
- Collaborate with other hospital staff and management to improve patient access and satisfaction.
- Analyze patient access data, including registrations, OP scheduling, referrals and all other applicable data and use it to identify opportunities for improvement, to include organization denial management.
- Keeping abreast of changes in healthcare regulations and industry best practices and incorporating them into patient access policies and procedures.
- Knowledge of all duties related to inpatient admissions, including pre-certification as needed to ensure accuracy and provide support if needed.
- Cross trained to provide support to staff when needed.
- Produces various reports and feedback as requested and addresses non-routine items with VP of Finance.
- Strives to create an atmosphere in the department that exemplifies excellent customer service and ensure a positive patient experience.
- Participate in various committees and meetings as assigned.
- Seeks out needed information, stay
ing informed and involved by attending meetings, reading memos, policies, meeting minutes, newsletters, email and other appropriate information in a timely manner. - Adheres to the organizational leadership profile
- Reliable attendance and punctuality.
- Performs duties in a safe manner, in compliance with all safety policies and procedures
- Complies with the Code of Conduct and all appropriate policies and procedures
- Other duties, as assigned, that are relevant to the position and department
PHYSICAL EFFORT AND ENVIRONMENT
Moderate: Occasionally lifts up to 25 pounds independently. Occasionally pushes/pulls 100 pounds. Stands or walks often.
EXPOSURE RISK
Exposure Category III: Employee not reasonably expected to be at risk for exposure to blood-borne pathogens.
QUALITY IMPROVEMENT
- Maintains current knowledge of the hospital-wide Quality Improvement Program.
- Develops and implements appropriate quality improvements for the department.
- Develops quality initiative projects and the methods necessary for initiating, testing, data collection, analysis, and reporting the effectiveness of the project.
- Establishes indicators to monitor departmental service in response to complaints, identified problems, variances, sentinel events, or new services as well as patient outcome-oriented indicators for high volume and/or high-risk services.
- Reports all Quality Improvement activities, measurements and results according to the established reporting structure.
- Participates in the annual review of the Quality Improvement/Patient Safety Program.
- Participates as a member of functional and/or process improvement team as appropriate to position or requested.
- Provides Quality Improvement orientation, training, and continuing education for all departmental staff.
- Involves all departmental staff members in the Quality Improvement Program’s plans and processes.
- Is accountable for identification and mitigation of risks and hazards within the department.
COMPLIANCE
• Adheres to the federal, state, and local statutes and regulations.
• Adheres to the Compliance Program policies and procedures of DECH/CCH.
• Adheres to all Privacy and Security policies and procedures of DECH/CCH.
• Communicates any concern related to compliance issues to Compliance Officer.
• Communicates any concern related to confidentiality issues to the Privacy Officer.
• Educate, train, and supervise staff on all related compliance issues.