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Intake Financial Clearance Manager - (Remote)

Remote, Remote
The Financial Clearance Manager has general oversight of the financial clearance functions for their designated team. This individual aids in setting goals, priorities, performance standards, policies, and procedures for the following functions: pre-registration, insurance/benefit verification, referrals, prior authorizations, and any related denials. The Financial Clearance Manager ensures that financial clearance is obtained prior to services being rendered, patient experience protocols are followed, and clearance is obtained in a timely manner to reduce related denials. This position has key responsibilities that directly impact reimbursement and the enterprise financial performance.

This individual will be involved in departmental and interdepartmental process improvement teams to eliminate waste and improve efficiency. They will partner with leadership and other internal and external customers to ensure timely completion of authorization, verification, notification to ensure effective precertification/authorization process is secured. He/She will work closely with all customers to ensure expectations are met on delivery of service offerings.


DUTIES & RESPONSIBILITIES:
Management and Training

Manage and develop Financial Clearance staff. Monitor staff engagement and implement ideas for improvements.

Manager is responsible for monitoring their teams progress based on performance benchmarks and addresses issues as they arise; identifies and quantifies mid-cycle revenue leakage and works with Vice President of Revenue Cycle to implement solutions.

Assist with making staff hiring decisions to maintain adequate staffing in the department.

Provide timely performance improvement feedback and coaching to include encouraging and commending staff for excellent performance.

Respond to escalated employee issues/questions/concerns.

Oversee the development of training materials and ongoing assessments; regularly review training materials to include new methodologies and concepts.

Actively seek and schedule staff development opportunities, including those outside the department that would be beneficial for staff members to attend. Identify focus areas for competency assessments; provide training opportunities addressing areas highlighted by these assessments.

Development and implementation of policies and procedures

Develop, recommend, and implement policies and procedures for the department. Monitor adherence to policies and established procedures. Propose methods which assure effective execution of program responsibilities.

Keep staff informed of all changes, provide keep focus work group attention to high profile process changes.

Operational Duties

Ensure that patient experience and service standards are met. Continuously gather, monitor and analyze departmental and program specific productivity and quality of service statistics.

Monitor the accuracy of demographic and insurance information obtained by staff for patient registrations and authorizations. Monitor billing edits to ensure accurate and timely claims submission. Investigate errors, suggest changes and/or implement solutions to encountered problems. Escalate issues to Vice President of Revenue Cycle when appropriate.

Keep abreast of insurance, referral, and billing requirements. Request system enhancements as needed to facilitate accurate registration.

Lead process improvement projects and assist with software implementation, upgrades, enhancements, and usability testing.

REQUIRED SKILLS:
Knowledge of Managed healthcare programs, Medicare, Medicare Advantage Plans, Medicaid, HMO’s, PPO’s , and IPA’s.

Intensive knowledge in managed care requirements as they relate to remote cardiac monitoring reimbursement.

Excellent verbal and written communication skills.

Effective interpersonal skills to facilitate work in a team environment and to collaborate with a variety of professionals.

Detail oriented, with a data driven attitude.

Strong decision making and self-motivation skills.

Ability to work in a team environment and to collaborate with a variety of professionals.

Experience with EHR systems

Ability to effectively incorporate the mission and core values into processes and workflows

Ability to effectively manage multiple demands; working under moderate to high degree of pressure

Excellent organizational skills.

Ability to maintain and convey a positive attitude and customer service approach to program development.

Ability to multitask and problem solve.

JOB REQUIREMENTS:
Bachelor’s degree in business, healthcare administration or a related field.

Four (4) years of experience in healthcare revenue cycle operations may be considered in lieu of degree with relevant experience.

Five (5) years of experience in a healthcare setting or three (3) years of related experience in a leadership role.




 

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