Patient Access Manager - Cherokee, United States - CHEROKEE INDIAN HOSPITAL AUTHORITY

Description

Job Code:
Department: Patient Access
FT/PT Status: Regular Full Time
Salary Minimum 58332
Salary Midpoint 72915
Position Closes:

Job Responsibilities & Qualifications:

Job Title: Patient Access Manager

Job Code: PR MGR

Division: Finance

Department: Patient Access

Salary Level: Exempt 3

Reports To: Chief Financial Officer

Last Revised:

Primary Function

The incumbent assumes the overall responsibility for the efficient and effective daily management of the Patient Registration and Switchboard Receptionist Department. They are responsible for: ensuring the customer world-class experience, ensuring the accuracy of the patient records (eligibility, demographics, and third-party billable information), managing and administering personnel policies and procedures, providing ongoing analysis of departmental effectiveness, and establishing new charts for patients. This position also serves as a liaison with the Billing Office, Health Information Management, Integrated Care Teams, ED, ICC, FCC, and Contract Health. Duties performed are in support of the Finance Division and Patient Registration Department in accordance with sound principles, CIHA policies and procedures, and CIHA mission, vision, and values.

Job Description

• Manages the day to day operation of the Patient Registration and Switchboard Department including recruiting, selection, training, and supervising of Patient Registration staff and switchboard.
• Perform selections, promotions, awards and corrective action.
• Ensure proper staffing in order to appropriately cover hours of operation and departmental requirements.
• Plans and facilitates training and development of staff to improve performance and implement industry changes.
• Monitor performance of Patient Registration clerks placed at other locations.
• Monitor and educate Patient Registration and Switchboard staff on their responsibility for proper registration of patients.
• Ensure they understand they are responsible for the correctness of verifying demographic information and eligibility.
• Train Patient Registration and Switchboard staff on proper sequencing in insurance and resolving questions concerning insurance and pre-certifications.
• Investigate and resolve customer concerns, patient or employee incidents in a timely manner.
• Communicate operational policies and organizational goals, mission, vision, values by utilizing regular staff meetings, as well as posting policies in a timely manner.
• Establish new charts for patients and determine eligibility of patient based on Indian Health Service and Eastern Band of Cherokee Indian eligibility guidelines and policies.
• Ensure that once chart has been established, patient receives next appointment with the primary care provider.
• Review new charts, established in ED, for completeness and accuracy and establish a permanent chart for these eligible patients.
• Ensure patients are referred to the Alternate Resources Officer to determine if patient is eligible for alternate resources.
• Identify, track, and report weekly bench mark indicators for Patient Registration Quality Assurance.
• Verify eligibility of existing patients to ensure proper services are provided based on the patient's eligibility.
• Maintain the Hospital's eligibility policy.
• Plan, coordinate, and document meetings with the Patient Eligibility Determination Committee. Patient eligibility that is not clearly defined will be presented to the Patient Eligibility Committee for rulings on a weekly or as needed basis.
• Streamline process as necessary to ensure patients move through registration without creating obstacles that lengthening time to see provider.
• Maintains additional files, records, reports and logs as required.
• Performs all job duties according to established safety guidelines and CIHA policies.
• Performs other duties requested by supervisor.

Member/Patient Service Duties

• Answers eligibility questions for new patients or Members and lets the individual know what the benefits are based upon eligibility status.
• Answers the Member/Provider 1800 Tribal Option line consistently and provides information, warm transfers, and referral information as appropriate and necessary to ensure callers needs are met. Member/Provider toll free number is to be answered during the CIHA Business Day defined as Monday-Friday 8:00-4:30, except for posted CIHA holidays.
• Follow approved Service Line scripts to ensure correct, consistent information is provided to the Member/Provider.
• Log every call received into the customer service platform to ensure appropriate documentation and resolution of all calls. This is the foundation of data that is required to be provided to the state as part of the PCCM Tribal Option Contract.
• Promptly returns calls to individuals or entities if a request for a call back is made after hours, the return phone call shall be made the following CIHA business Day during normal hours of operation.Triages the message and notifies applicable business owner based upon the type of information requested.
• Answers telephone switchboard for all CIHA facilities and directs calls to appropriate staff member/department.
• Maintains an updated list of all departments, personnel, and extensions to assure proper transfer of calls.
• Greets visitors when necessary, answers questions, or directs them to the appropriate person or department.
• Maintains the vendor/visitor sign in and provides vendor/visitors with Visitor badge.
• Keeps a log of after hour call-in referrals and turns into PRC during regular business hours.
• Determines the need for interpreter or translation services and accesses the necessary platform(s) to ensure the individual receives communication in the manner necessary to provide effective communication with the individual.This includes but not limited to calls to/from Members with limited English Proficiency, as well as Members with communication impairments, including those with hearing, deaf-blind callers to include TTY, captioned phones, and amplified phones.
• Assists the manager with returned mail documentation and processes.

Documenting Member/Provider Grievances

• Document all Provider or Member grievances/complaints received via the service lines or in person.
• Provide complete and appropriate documentation of all complaints/grievances within the customer service platform.
• Elevate complaint/grievances to the appropriate Tribal Option Manager per policy/protocol.

Job Knowledge

• Demonstrated ability to supervise employees.
• Ability to manage a program or department.
• Knowledge and skill of teaching and implementing exceptional customer services standards.
• Must have leadership, analytical, oral presentation, and decision-making skills.
• Outside the organization. Ability to communicate to and interact with persons (staff, health care professionals, individuals in the community) with different functions, levels of knowledge, and requirements.
• Ability to maintain quality safety and infection control standards.
• Knowledge and ability to independently plan, manage, and organize work in order to meet priorities, accomplish work within established time frames and work in stressful situations.
• Ability to solve problems related to data collection, planning, implementing, evaluating, and modifying methods and techniques.
• Knowledge of the occupational functions of multi-disciplinary health care teams.
• Knowledge of the culture and medical health profile of the patient population.
• Knowledge of available health care programs and community resources.
• Knowledge and skills in operating a computer, a PBX system and ability to use word processing, spreadsheet, and database programs.
• Knowledge of electronic medical record methods.
• Knowledge of JCAHO accreditation standards, personnel regulations and safety standards.
• Ability to gather and analyze data and communicate findings.
• Applicant must have a valid State driver's license.
• Must be able to develop and maintain effective working relationships with fellow managers and area administrators.
• Requires the ability to research and compile questions concerning patient eligibility for services at Cherokee Indian Hospital Authority, patient demographics, insurance prioritization, and create reports that properly reflect the outcomes of patient registration.
• Must be able to communicate; verbally and in writing.
• Ability to work independently or as a team member is required.

Experience and Job Training

Specific work experience of four (4) years would provide sufficient work background to qualify for the job. Supervisory experience is preferred. Experience in a hospital or health related field is preferred. Six to twelve months would be required to learn most phases of the job.

Schooling or Equivalent

A Bachelor's Degree in Business, Health Information Management or a related field with 2 years of health administration experience is required.

Contact with Others

Has frequent contact with CFO, Accounting Manager, Business Office Manager, Medical Records Manager, and Contract Health Services Manager, coworkers and CIHA leaders, and with occasional contacts with auditors. Nature of contacts requires tact, courtesy and professional etiquette to maintain positive working relationships.

Confidential Data

Has access to CIHA's Patient information, employee wages and other related financial information associated with Patient Registration, which should remain confidential; must adhere to all CIHA confidentiality policies and procedures.

Responsibility for Accuracy

Must perform complex mathematical computations, which are usually verified through RPMS. Undetected errors could require time for research; results could range from minimal to extensive in scope. Work is generally reviewed by others for accuracy and compliance with regulations and procedures.

Mental/Visual/Physical

Close concentration and attention to detail are required while performing all Patient Registration procedures. Is subject to frequent interruptions requiring varied responses. Must have physical mobility, reaching with arms and hands, manual dexterity and visual acuity. Must be able to speak and hear effectively. May occasionally lift more than 15 pounds.

Resourcefulness and Initiative

Works within well-defined procedures and guidelines. Uses judgment and initiative to maintain accuracy, respond appropriately to questions and establish work priorities.

Environment

Works in a normal business office in performance of job duties.

Customer Service

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA's guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.