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Patient Access Services Manager Facility: OSF St. Joseph Medical Center
Bloomington IL, 61701
Department: Revenue Cycle Patient Access - SJMC Schedule: full-time Shift: Variable Hours: Variable Hours Per Pay Period: 80 Referral Bonus: Job Details:
Position will be located at OSF St. Joseph Medical Center, Bloomington, IL
Managers are primarily responsible for and must demonstrate knowledge and expertise in one of the below Revenue Cycle areas of focus. However, Revenue Cycle Managers are expected to have general knowledge in all areas of focus. Managers are responsible for assisting with the overall departmental planning, trend analysis and evaluation of the department’s performance and providing regular performance updates to the Patient Access Services Director and are responsible for supervising assigned Patient Access Services staff.
These positions will report to the Patient Access Services Director and are responsible for the administration and management of all personnel and functions of scheduling, pre-registration, outpatient registration, emergency room registration, inpatient and same day admissions, discharge, financial clearance (insurance eligibility, benefits verification, authorization/referral management, payor notification, pre-service/point of service cash collections) and financial counseling functions.
Primary responsibilities include ensuring the collection of comprehensive and accurate demographic and financial data to optimize timely billing and collection of accounts receivable, supervising and monitoring personnel daily, communicating regularly with staff and supervisor to keep abreast of issues and to provide evaluations/feedback, carrying out organizational policies and procedures, recruiting/retaining/training staff, and establishing unit goals and objectives.
Spoke Manager Focus:
- Scheduling: Scheduling patient appointments appropriately as required. Enters orders into the electronic medical record ensuring that data is complete and accurate. Maintaining scheduling templates, including holiday schedules, as required.
¡ Registration / ED Registration: Collection of full and complete demographic and financial dataset from the patient or responsible party for entry into the computer system. This event occurs at the time of service (for walk-ins, ED, etc.)
¡ Financial Clearance: Completing all necessary functions to expedite patient processing and reduce the financial risk to the organization by performing:
o Insurance Verification: Validating active insurance coverage
o Benefits Verification: Confirming benefits for services including exact coverage, effective date of the policy, coverage limitations / requirements, and patient liabilities
o Authorization / Pre-certification: Gaining payor authorization / certifications for a patient
Referral Management: Securing a referral from the Primary Care Physician (PCP)
o Payor Notification: Notifying the payor of an inpatient admission or discharge
¡ Financial Counseling: Working with patients who have, or potentially have high liabilities, and assisting them with identifying possible alternate funding sources, arranging acceptable payment plans, or screening them for sponsorship assistance
¡ Point of Service Cash Collections: Collection of patient payment obligations at time of check-in
o Manual cash posting: Posting of cash amounts to host system, including balancing of cash drawers, and ensuring accurate posting to the general ledgers
o Cash Reconciliation: Reconciliation of cash between patient accounting system and transaction records
PRINCIPAL DUTIES AND RESPONSIBILITIES
ESSENTIAL JOB FUNCTIONS:
1. Demonstrates good organizational skills in coordinating services with co-workers and other departments/services. Responds to stressful situations in a calm and rational manner, and cooperates with all to facilitate integration of services.
2. Conceptualizes, develops and implements all policies and procedures for the various departmental functions; monitors the progress of the departments’ short and long-term goals; develops and implements the strategic plan concerning the above functions for the ongoing Department reorganization.
3. Responsible for enhancing and maintaining properly functioning Patient Access Services processes through a cross-departmental organizational structure.
4. Ensures efficient work flow, resolution of difficult problems, monitoring of quality assurance measures, and enforcement of consistent Patient Access Services departmental and system policies.
5. Establishes annual and monthly department and performance goals jointly with Patient Access Services Managers.
6. Assists in the development of annual goals and departmental budgets, resolving issues regarding Patient Access Services as necessary, interacting with internal and external OSF parties, and directing performance improvement initiatives to respond to changing market trends.
7. Performs data analysis and prepares special analytical reports for Senior Management. Interprets reports and databases originating from computer systems within OSF facilities.
8. Responsible for the development and implementation of all aspects of the Patient Access Services Department’s continuous quality management programs for centralized and decentralized areas.
9. Develops and maintains positive working relationships with leadership teams across OSF.
1. Responsible for performing human resources functions including hiring, disciplinary action, performance appraisals, orientation and training for department staff. Interview, select and hire employee and make termination decisions.
2. Conducts regularly scheduled team meetings to communicate issues regarding compliance with established procedures and overall work unit effectiveness. Reviews changes in processes or payor requirements and communicates as appropriate.
3. Prioritizes and organizes work within department to meet changing priorities and maintains regular contact with staff to keep abreast of issues and to provide feedback on overall operations and specific issues.
4. Oversees the development and maintenance of training programs. Ensures training materials and programs address the needs of the department and organization.
5. Prepare and monitor various reports regarding the telephone data system to ensure that patient and MSO client calls are being answered in a most efficient and timely manner.
6. Monitors unit and staff for compliance with regulations of outside agencies, e.g., OSHA, JCAHO, Illinois Department of Public Health, etc. and takes corrective actions as necessary.
1. Conforms to the personnel policies, safety, work and compliance practices that govern the position.
2. Attends required meetings and participates effectively in groups as requested. Completes annual mandatory requirements. Effectively participates in departmental quality improvement initiatives.
3. Oversees the evaluation and recommendations of programs and procedures for improved operations, modifications to and/or implementation of new procedures.
4. Works to ensure full utilization of technology and processes to create an efficient and effective department. Works with IT / Telecommunications to escalate and resolve relevant issues to maintain day-to-day operations. As necessary, participates in review and selection of relevant technology enablers / tools to support Revenue Cycle functions.
5. Manages special projects as assigned; responsible for coordinating activities with others in the department to produce reports and other deliverables within the prescribed time frame.
6. Maintains current knowledge of and complies with all state, federal and local procedures related to OSF Revenue Cycle functions
7. Provides excellent customer service to all customers – patients and their family members, physicians and other clinicians, and internal departments (e.g. Patient Financial Services, Scheduling Departments)
1. Communicates and meets directly with Physician and Hospital Leadership concerning Patient Access Services processes. Ensures timely and efficient integration of all outpatient, inpatient, discharge requirements, financial clearance and financial counseling functions into the OSF overall financial and patient care programs.
2. Provides guidance and feedback to other Revenue Cycle and Clinical Departments about denials, appeals, their outcomes, and payor requirements.
1. Oversees the handling of "special handling" requests, complaints or inquiries regarding patient access to ensure correct and satisfactory resolution.
2. Implements enterprise-wide projects, as assigned, for realizing process improvement opportunities within Patient Access Services.
3. Keeps current on new or changes in regulations and organizational policies, and works with management team and staff to determine impacts of such changes
4. Participates on teams and projects throughout OSF Healthcare System as requested.
MARGINAL JOB FUNCTIONS
1. Performs other related duties as assigned.
KNOWLEDGE SKILLS AND ABILITIES REQUIRED
Bachelor's Degree (BA or BS) or Associates Degree with emphasis in Business or Health Administration is preferred. Five years of progressively more responsible health care management experience.
1. Working knowledge of the principles and fundamentals related to budgeting, accounting, record keeping and business writing, as well as knowledge of general administrative procedures such as payroll, vendor management, purchasing, are required.
2. Requires strong knowledge of scheduling, registration, financial clearance and financial counseling processes with particular focus on payor financial requirements.
3. Requires knowledge of hospital operations and patient flow so as to be able to identify and analyze potential sources of error or patient dissatisfaction.
4. Requires knowledge of healthcare accounts receivable management concepts, including in-depth knowledge of the state and federal reimbursement and regulatory environment so as to ensure compliance with State and federal regulations regarding patient and insurance billing issues.
5. Requires up-to-date knowledge and understanding of Federal compliance and OIG initiatives that impact the healthcare industry.
6. Requires understanding of current and future trends/practice in Patient Access Services.
7. Requires knowledge of information systems and software used in Patient Access Services, and of equipment used in performing assigned duties.
8. Requires basic knowledge of medical terminology.
9. Requires excellent customer service skills, interpersonal ability and demonstrated leadership skills to regularly interact with Administration, medical staff, nursing personnel, all other hospital professionals, and external health care professionals.
10. Requires analytical ability to complete high-level problem-solving, develop and provide direction in the implementation of short and long-term departmental goals; provide administrative direction to personnel in the resolution of problems or difficult tasks.
11. Must possess supervisory skills for accepting responsibility, making decisions, directing, delegating and supervising personnel.
12. Excellent communication and organizational skills required.
13. Must possess ability to investigate, analyze and resolve departmental issues.
14. Must possess ability to work efficiently and accurately, and to organize and plan work.
15. Requires process improvement skills and the ability to develop and execute a plan of action.
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