Manages the financial clearance functions for DCH Regional Medical Center setting goals, priorities, performance standards, policies and procedures for the following functions: Good Faith Estimates, insurance/benefit verification, Financial Counselors, Alabama Field Navigator, Patient Financial Assistance Program, and Post-Reg. This position has key responsibilities that directly impact reimbursement and the hospital’s financial performance. This position will be involved in departmental and interdepartmental process improvement teams to eliminate waste and improve efficiency.

1. Oversee Financial Counselors, Alabama Field Navigator, and Post-Reg staff.
2. Skillful to interview patient to obtain legal relevant medical information and all required documentation for eligibility determination and accurate application completion avoid rejections /delay in payment; increase to AR.
3. Screen and evaluate patients for existing insurance coverage, federal and state assistance programs or hospital charity application.
4. Screen uninsured patients for state and federal insurance programs; Medicaid, All Kids Marketplace, Medicare or VA Programs.
5. Works with vendors, billing, and/or case management to ensure secured reimbursement to DCH prior to services or before patient is discharged and mitigates at risk accounts from moving through collection process.
6. Works with both sides of the revenue cycle management to align revenue cycle processes to present a unified patient experience and consistent capture for Clean Claim Processing.
7. Provides reports and analysis to Assistant Director on insurance discoveries or secured Medicaid, Marketplace or charity applications.
8. Counsel patients on insurance benefits, copayments, and coinsurance amounts. Assist patients with payments, payment plans, or applicable options to ensure DCH is reimbursed for services rendered.  
9. Operates as collector to accept patient payments via cash, credit or checks. Documents applicable systems and provides patient receipts.
10. Ensure all insurance, demographic, and eligibility information is entered into the EMR accurately and appropriate signatures are obtained on all required forms for clean claim processing.
11. Serves a liaison between the patient, hospital and governmental agencies; actively involved in financial areas of case management for supportive patient advocacy for best patient experience.  
12. Initiate and complete charity application on at risk accounts or items not obtained at the time of registration to avoid financial loss or payment denial for DCH.
13. Maintains proper follow-up with the patient and governmental agency caseworkers to ensure timely processing to include request for additional information.
14. Works report each week and documents account notes of application status for all pending applications.
15. Escalates at risk accounts to leadership.
16. Reviews financial data and multiple program requirements to determine possible Marketplace eligibility or other government insurance.  
17. Assist with optimizations of Patient Access software and rollouts.
18. Exercise problem solving skills independently or within a group setting for best financial outcomes.
19. Verifies or re-verifies benefits or initiates or obtains authorization and/or referrals to include validation of traditional or HMO plans, commercial coverages within payer timelines to ensure reimbursement to DCH.
20. Works collaboratively with Case Management and Discharge Planning for awareness of community resources to engage patient and family members as needed.
21. 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 Revenue Cycle leadership when appropriate.
22. Prepare, maintain and balance yearly budgets for applicable cost centers. Manage budget over the fiscal year.
23. 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.
24. Understanding of all regulatory, HIPAA and payer guidelines.

Manager

• Manages departmental budget
• Interviews, selects, hires, and retains employees
• Ensures orientation and training for employees
• Manages performance
• Promotes, demotes, or transfers employees to meet organizational needs
• Executes employee accountability process up to and including termination
• Manages departmental productivity standards
• Performs compliance requirements
• Approves payroll and is responsible for accurate payment of employees
• Manages front line operations of area of accountability related to meeting/exceeding departmental goals

DCH Standards: 

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.

• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.

• All other duties as assigned.

Associate Degree OR prior advocacy experience or applicable Revenue Cycle Experience of a least two years in a healthcare setting required.  Good Communicate skills.  Must be able to read, write and speak English.  Must be able to interact well with the public and staff.

WORKING CONDITIONS

Carry up to 30 pounds, occasionally required to push, pull, bend and lift.  Ability to push a wheelchair, assisting with entry or exit.  Able to stand, walk, kneel, sit or stoop with good balance for extended periods of time or when visiting patient rooms or clinical units to interview patient and obtain information. Vision and hearing normal or corrected to normal.  Can write legibly.  Must have ability to communicate with others.  Mental capability to maintain patient confidentiality 100% of the time.  Subject to stress and fatigue.