Financial Clearance Manager - Baltimore, United States - Medasource

Description

Position: Surgery Financial Clearance Manager

Location: Remote.

Duration: 6 month Contract to hire

Start Date: ASAP

POSITION SUMMARY:

Reporting to the Health System Director of Financial Clearance, this position provides strategic direction, goals, and objectives for financial clearance functions. Oversees financial clearance operations. Creates a culture of patient centered care and customer service, consistent with the Johns Hopkins Medicine's Mission, Values and Vision.

Collaborates with staff and leadership within the organization to drive standard processes and ensure consistency of practices as well as continuous process improvement within financial clearance. Recognizes cross functional interdependencies of decisions. Provides more complex analysis, advice and coaching in response to business issues and executes appropriate shared services strategy. Makes decisions in fast-paced, fluid environment where limited precedents exist; actively collaborates with key business and functional partners accurately and within defined service level agreements. This position also requires integral participation in communication and quality improvement initiatives with patients, insurance companies, department administrators, physicians, and other departmental staff to ensure the ideal patient experience.

Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. Participates in programs and in using tools in support of building a high-performance culture via the standard Johns Hopkins Medicine Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.)

Responsibilities:

• Provides direction, leadership, and support to the Financial Clearance department to ensure accounts are worked in a timely basis, validating insurance benefits, medical necessity request and prior authorizations submitted to payers, ensures pre-service collection occurs prior to service when appropriate based on insurance benefits, and that services are financially cleared
• Accomplishes financial clearance human resource objectives by recruiting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures to ensure the department is adequately staffed
• Oversee that all patients requiring prior authorization for services are financially cleared prior to services being rendered and that staff are trained and given tools and resources to submit authorization request and supporting documentation on a timely basis to reduce delay in service and/or prevent denials
• Responsible for managing and reducing denials by monitoring and improving financial clearance processes
• Leads the Financial Clearance staff using effective leadership techniques consistent with Johns Hopkins Medicine philosophies
• Collaborates with staff, leadership, front end leads within the organization to create standard processes across the system and ensure consistency of practices as well as continuous process improvement
• Creates a culture of Patient Centered Care and Customer Service, consistent with Johns Hopkins Medicine's Mission, Values, and Vision
• Establishes and maintains high quality customer service ratings
• Ensures compliance with all Local, State and Federal regulations
• Ensures effective communication links are created and maintained between all departments of responsibility, including Patient Access services, Pre-Registration/Registration, Utilization Management/Care Coordination staff as well as Johns Hopkins Medicine Central Business Office
• Develops and maintains ongoing working relationships with hospital leadership, physicians, and contracted vendors to effectively anticipate or resolve problems using clear communication
• Ensures efficient use of resources · Assumes responsibility to achieve work goals within budgetary constraints while maximizing human resources; assists in developing department goals and objectives
• Ensures department operates in accordance with government, legal, Compliance and Risk Management
• Ensure adherence to HIPAA and patient privacy · Complies with the requirements of the Code of Conduct, corporate compliance plan and compliance policies and procedures, including training requirements

Management

• Works with Financial Clearance Team to implement and execute programs, policies, initiatives and tools
• Stays abreast of the latest developments, best practices and trends in Financial Clearance and other functional areas that may impact the shared service organization
• Ensures delivery of business results by meeting or exceeding all contractual service level agreements

Leadership

• Identifies, develops, and implements ways to improve work processes, enhance quality, productivity, and service delivery
• Demonstrates commitment towards continuous improvement and willingness to challenge existing practices
• Works with Financial Clearance Supervisors, and Specialists to ensure the direction and success of the Financial Clearance Team · Manages key performance indicators and metrics

Education:

Requires Bachelor's Degree in Accounting, Business Administration, Health Administration, Finance, Information Management or related field. Master's Degree preferred.

Knowledge:

• Knowledge and experience in patient access functions, financial clearance, and revenue cycle management principles. Minimum of two years comprehensive
• Knowledge of third-party payer requirements, computer literacy and customer service skills.
• Familiarity with general hospital management principles, practices, and procedures
• Advanced knowledge and demonstrated proficiency in medical insurance plans, billing and regulations, and manage care plans
• Knowledge of patient access functions in acute and non-acute settings including organization, registration, financial clearance, and financial counseling functions and how they interrelate
• In-depth working knowledge of medical terminology and coding
• Working knowledge of CPT and ICD-10 codes as they relate to financial clearance
• Knowledge of Financial Clearance Management information system applications
• Knowledge of system interfaces
• Knowledge of reimbursement systems (DRGs, capitation, managed care, etc.), the Medicare Peer Review Organization, The Joint Commission accreditation standards, state licensing requirements, and state and federal laws, standards, rules, regulations and requirements governing the confidentiality of patient information is essential
• Knowledge of work standards and productivity measures, quality control mechanisms, and workload distribution
• General knowledge of LEAN, Six Sigma, reengineering and/or other process improvement knowledge/experience desired
• General knowledge of HR and payroll policies/regulations, automated timekeeping systems and budget practices
• Knowledge of technological advancements, labor savings procedures processes/equipment and other state-of-the art department-specific systems
• Knowledge of utilization review principles/practices