Senior Manager Patient Access

Position Summary

 

The Senior Manager Patient Access manages the workflow and process of data capture prior to actual provision of care. This role focuses on maximum reimbursement and compliance. The role is instrumental in provided best in class patient access to ensure patients receive care, while also ensuring that benefits are verified, prior authorizations are obtained and placed in system, along with patient estimates prior to care being provided. Responsibilities include all aspects of the registration, eligibilities and prior authorization support including performance management, development, documentation, testing, training and upgrades. The position will also incorporate leading patient access staff as organizational needs change.

 

Duties and Responsibilities

 

· Improve team production and efficiency by reviewing and analyzing reports and workflow processes and recommending changes that will positively impact patient flow and help the company operate according to industry benchmarks and meet performance goals and productivity.

· Analyze schedule, payment and charge discrepancies to determine issues, area of responsibility and assist in the development of corrective action plans.

· Design metrics to measure staff and system(athena) performance.

· Compare prior authorization trends from region to region on top codes/payers/reimbursement rates.

· Design metrics for reassuring prior auth denial percentages by site/denial type/CPT.

· Responsible for ad-hoc reporting requests as needed.

· Allocate staff assignments to ensure KPIs for department are met

· Update practice management system configuration as needed to ensure accurate submission of authorizations, and engage with athena build team to ensure orders are built to needed specificity for authorizations.

· Responsible for all daily communications between department staff and all medical practice locations.

· Identify revenue holdups as related to prior auths as quickly as possible/coordinate timely resolution.

· Meet with staff regularly to review denial trends/processes/procedures.

· Adhere to and uphold all applicable federal and state compliance regulations, the NSPC Code of Conduct, the NSPC Employee Handbook, compliance policies and procedures, and applicable healthcare fraud, waste and abuse laws.

· Understand, comply with, and enforce all NSPC policies, procedures, codes of conduct, and OSHA and HIPAA privacy rules.

· Ensure adherence to all compliance standards among all NSPC colleagues and staff, including those managed or overseen.

· All other duties as assigned.

Qualifications and Skills

· Bachelor’s degree in Accounting or related field, or equivalent experience

· A minimum of five years in medical practice.

· A minimum of two years in a supervisory role.

· General experience with CPT coding and 3rd party billing requirements.

· Working knowledge of Medicare, Medicaid, BlueCross/BlueShield, Worker’s Compensation, Managed Care and commercial insurance carrier billing regulations.

· Prior experience with AthenaOne preferred

· Superior proficiency with Microsoft Office Suite, specifically Excel (including pivot table experience).

· Introductory SQL knowledge is preferred.

· Ability to perform all duties in an independent manner with minimal direction and supervision.

· Excellent organizational/multi-tasking skills with acute attention to detail.

 

Working Conditions

 

· Located in a fast-paced, professional office environment with a noise level that is generally moderate.

· Regular use of standard office equipment (including computers, phones, photocopiers, filing cabinets, fax machines, etc.).

· Ability to travel company-wide is necessary.

 

Physical Requirements

 

· Extensive and regular periods of sitting, standing, bending, walking, seeing, talking, and listening.

· A full range of body motion including complete manual and finger dexterity, as well as effective hand-eye coordination.

· Adequate visual acuity including ability to read information.

· An occasional requirement to reach with hands/arms, stoop, kneel, or crouch.

· An occasional requirement to push, pull, lift and/or move up to 10 pounds.

· The ability to operate a motor vehicle with a valid driver’s license, as needed.