- Oversees and accountable for operational functions of financial clearance operations for Nuvance Health related to pre-service registration, insurance verification, authorization, estimates and pre-service collections for hospital services and centralized medical practice area.
- Partner with revenue cycle and non-revenue cycle leaders to collaborate on workflow to establish efficiencies and best practice to secure revenue for the network.
- Responsible for meeting strategic goals for rate of clearance prior to time of service, pre-service collections by procedure type, and aggressively low denial and error rates meeting established KPIs.
- Responsible for denials identification and remediation of root causes, submit appeals, funnel education back to responsible parties, and track success towards future prevention goals.
- Oversees and supports estimator tool for the Network, adhering to all regulatory standards and organizational policies, procedures and guidelines established by the organization.
- Accountable for overseeing the pre-bill function, including rejections and EBEW Patient Access errors for Hospital and Medical Group claims. Ensures errors are corrected and trended to appropriate registration areas so that follow up with department.
- Collaborates with decentralized areas for education opportunities on denial prevention and effective appeal writing to overturn administrative denials. Provides support for de-centralized financial clearance, or act in a consultant role to redesign workflows and share best practices. Leads initiatives to improve efficiency through use of eligibility related automation.
- Manages a complex group of relationships to include clinicians, patients, employers, insurance companies, health plans, and managed care. Meets with stakeholders on a regular basis to identify opportunities for improvement leading to patient and physician satisfaction and seeks operations improvements to gain efficiencies.
- Assists in build of payer-specific rules through knowledge of payers, insurance eligibility process, and the financial clearance workflow applicable to our financial application. Maintain system rules for eligibility tools to support an efficient process.
- Works collaboratively with managed care and business office to identify opportunities identified within financial clearance, provide feedback to improve reimbursement to improve contracts and facilitates single case agreements.
- Manages the budget for financial clearance departments.
- Fulfills all compliance responsibilities related to the position. Ensures all financial clearance processes are in line with all state and federal requirements, and that all HIPAA policies are maintained as related to patient rights.
- Manages staff to include hiring, conducting performance reviews, counseling, disciplinary action, and overseeing staff educational development. Provides coaching to management team as needed. Provides ongoing educational opportunities based on industry offerings.
- Work with clinical areas to support and provide guidance on best practices for revenue cycle opportunities including financial clearance.
- Performs other duties as assigned.
- Bachelor's Level Degree
- Significant manual skills / motor coord & finger dexterity
- Little or no potential for occupational risk
- Sedentary/light effort. May exert up to 10 lbs. force
- Generally pleasant working conditions.
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Director Patient Access Pre-Services - Danbury, United States - Nuvance Health
Description
Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
Non-acute care is offered through various affiliates,Summary:
The Director of Financial Clearance is responsible for daily operations and functions of financial clearance for Nuvance Health Financial Clearance Department including insurance verification, authorization, pre-registration, price estimation and single case agreements.
Responsibilities:
Education and Experience:
Required:
Bachelor's degree and 7-10 years of healthcare revenue cycle experience and management experience.
Preferred:
Master's degree and 7 years of healthcare revenue cycle experience. National Association of Healthcare Access Management CHAM certification. AAPC Certified Professional Coder (CPC) certification.
Location:
Summit-100 Reserve Rd
Work Type:
Full-Time
Standard Hours: 40.00
FTE:
Work Schedule:
Day 8
Work Shift:
Day shift hours
Org Unit: 1966
Department:
Financial Clearance
Exempt:
Yes
Grade:
L2
Salary Range:
$ $ Hourly
Education:
Essential:
Working conditions:
Essential:
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business.
