Under the direction of San Joaquin County Clinics (SJCC) executive management, manages the Patient Access Services operations, which includes patient registration services, insurance eligibility and authorization on behalf of SJCC; and does related or other work as required in accordance with Rule 3, Section 3 of the Civil Service Rules.
CLASS CHARACTERISTICS
The incumbent in this single position class has overall management responsibility for Patient Access Services operations, and the overall Revenue Cycle for the San Joaquin County Clinics (SJCC). This position manages initial patient interactions in regards to registration and intake, including financial screening and insurance eligibility and authorization for SJCC; and ensures compliance with applicable regulatory requirements.
TYPICAL DUTIES
Plans, organizes and directs the Patient Access Services for SJCC operations that includes financial screening, patient registration, review of payment plans, ensure compliance with federal sliding fee scale guidelines, maintenance of patient data, verification of insurance benefits and the establishment of third-party coverage.
Develops and maintains policies and procedures to ensure compliance with regulatory requirement standards. Provides operational guidance and education to SJCC providers and senior management to maximize Federally Qualified Health Center (FQHC) revenue and minimizing payer denials.
Manages the activities and daily operations of patient access services and revenue cycle functions that include: intake, insurance billing, charge description master, clinic registration and scheduling, cashiering, revenue cycle/collection, provider relations, patient eligibility, and patient financial counseling.
Facilitates and/or participates in administrative meetings, special projects, and program development; both within and outside the organization as needed and provides operational status reports to SJCC leadership and board of directors to meet Health Resources and Services Administration (HRSA) requirements per the HRSA Compliance Manual and HRSA Site Visit Protocol.
Manages the Patient Access Services budget to ensure compliance with FQHC guidelines and SJCC organizational goals.
Conducts ongoing assessment of unit operations to ensure revenue cycle performance objectives are achieved through efficient patient financial services guidelines and procedures; and recommends modification of data processing and utilizations for continuous improvement to maximize overall performance of SJCC clinic services.
Manages the hiring, selection, and training of patient registration personnel, and maintains training documents and training curriculum for FQHC staff and providers pertaining to payer contracts, Medi-Cal and Medicare regulations, and other FQHC reimbursements.
Advise SJCC providers and staff regarding service payments and reimbursement eligibility requirements to maximize and protect reimbursement; oversee third party denials to assure timely appeals and responses to maximize revenue for clinical services rendered.
Interprets federal, state and local regulations, contracts and agreements as related to utilization review, outpatient reimbursement, and makes recommendations to SJCC administration for compliance; and recommends solutions to resolve the more complex problems/accounts that occur in any of the areas of responsibility.
Prepares and reviews reports and correspondence regarding SJCC patient access services statistics as needed or required; and recommends modification of data processing and utilizations for continuous improvement to maximize overall performance of SJCC clinic services.
MINIMUM QUALIFICATIONS
Education: Bachelor’s degree from an accredited four-year college or university with a major in public or business administration, health care management, social sciences or a closely related field.
Experience: Three years of healthcare revenue cycle, medical credit and insurance, welfare eligibility, FQHC registration or hospital admitting or directly comparable experience, including one year of supervisory experience over patient access or revenue cycle activities in a hospital, clinic or health care organization. Preferred experience includes revenue cycle and patient registration management at a Federally Qualified Health Center (FQHC).
Substitution: Additional qualifying experience may be substituted for the required education on a year for year basis.
KNOWLEDGE
FQHC payer and revenue cycle expertise; project and change management training; principles and techniques of personnel supervision and training; basic data processing concepts and functions; principles and techniques of gathering and organizing data and statistical analysis; principles and practices of utilization review; basic principles and practices of public and business administration; principles and practices involved in patient access or revenue cycle activities, including knowledge of applicable health information systems; laws, rules, regulations, and policies affecting revenue cycle or patient access functions. Private and third party (Medicare/Medi-Cal) insurance authorization and claiming procedures, rules and regulations.
ABILITY
Create, interpret, and implement policies and procedures; establish and implement best practices; schedule and assign work, train staff; establish and evaluate priorities; read, interpret, explain and apply regulations, laws, rules and procedures related to patient access or revenue cycle operations; develop and implement work procedures and systems to meet required standards; prepare clear and concise oral and written reports; communicate effectively; analyze situations accurately and take effective action; establish and maintain effective working relationships with patients, physicians, staff, outside agencies, community partners and the public; negotiate admitting and payment arrangements; ability to quickly and accurately access and resolve complex admission, billing and treatment authorization issues.
PHYSICAL/MENTAL REQUIREMENTS
Mobility-Frequent operation of a data entry device; frequent sitting, standing, and walking for long periods; occasional driving, climbing stairs, pushing, pulling, bending, and squatting; Lifting-Ability to occasionally lift up to 15 pounds; Vision-Constant reading and close-up work and good overall vision; frequent eye/hand coordination; occasional color/depth perception and peripheral vision; Dexterity-Frequent holding, grasping and writing; occasional reaching and repetitive motion; Hearing/Talking-Constant hearing normal speech, talking in person and on the telephone; occasional hearing faint sounds; Emotional/ Psychological-Constant public contact, decision making and concentration; frequent working alone; Special Requirements-May occasionally work weekends/nights/overtime; may be required to travel; Environmental-Occasional exposure to noise, may occasionally work weekends/nights/overtime; may be required to travel; Environmental-Occasional exposure to noise.
San Joaquin County complies with the Americans with Disabilities Act and, upon request, will consider reasonable accommodations to enable individuals with disabilities to perform essential job functions.
Notify Me when a Job Opens for the above position(s)