Manager, Patient Financial Services Job in Hayward, California US
Manager, Patient Financial Services
Responsible for planning, directing and managing patient financial advisor operations within a medical center (hospital and clinics), the manager patient financial advisor focuses on enhancing members experience within the Kaiser Permanente system by developing and implementing streamlined, customer-friendly processes for handling all financial liabilities associated with members care. Promotes programs that support timely and appropriate linkages to alternative coverage opportunities, including medical financial assistance. Must exhibit a passion for member advocacy and a desire to collaborate with teams across departments. Essential Functions: - Provide strategic oversight to operations. - Responsible for the day-to-day operations of a team of patient financial advisors and support staff. - Accountable for an integrated member advocacy strategy, working in partnership with member services. - Coordinates with admitting, utilization review/utilization management, social services, patient care services and discharge planning to facilitate appropriate financial sponsorship, authorization, reporting, and discharge process compliant with payer and government regulations. - Insures timely and accurate coverage assessment of all inpatient hospital patients. - Insures adequate patient financial advisor coverage for at risk hospital admissions, emergency room visits and high dollar hospital outpatient services. - Supports revenue cycle leadership in the development of tactical plans, operating budgets and the provision of resources to achieve strategic goals. - Collaborates with the revenue cycle administrator and regional revenue cycle leadership, colleagues and subordinates to drive charity care initiatives. - Works in partnership with regional charity care, community benefits teams and community based organizations - Works with patients/members as needed, resolving difficult issues. - Accountable for external vendor performance and relationship for services supporting eligibility or linkages to other coverage or payer sources. - Hire, coach, develop, discipline and terminate staff as necessary. - Recruits, develops, and maintains competent and productive team. - Responsible for the payroll, non-payroll and capital budgets. - Provide leadership to the patient financial advisors and the medical center operational teams. - Provide consultation and recommend solutions to difficult eligibility and admission problems. - Engages clinicians, managers and staff in problem solving coverage or financial sponsorship opportunities. - Provides education and direction as a servant leader to direct reports and medical center constituents. - Identifies cross-functional opportunities and provides support to assist with the implementation of revenue cycle performance improvement actions. - Drive operational improvement in the hospital and clinics through review and management of performance metrics. - Monitor and report key revenue cycle metrics related to sponsorship identification and medical financial assistance to appropriate revenue cycle leadership. - Facilitate compliance with administrative/legal requirements and governmental regulations. - Monitor departmental compliance with internal controls (Sarbanes Oxley) and develop remediation plans to address identified control weaknesses. - Ensures all practices relating to the acquisition and maintenance of information comply with federal, state and hospital regulations, policies, and procedures. Qualifications: Basic Qualifications: - 3 + years of experience in an acute care hospital environment. - 5 + years of relevant progressive leadership role. - Bachelor's degree in Business Administration, Finance, Health Administration, Social Work, or related field or equivalent work experience. - Working knowledge of Knox-Keene and Federal HMO Acts preferred. - Working knowledge of commercial, government and charity care eligibility and a special focus on patient/member satisfaction. - Demonstrated ability to lead multi-disciplinary teams through complex, medical, social and financial conversations. - Demonstrated ability to utilize effective financial management tools, information systems methodologies and supervisory techniques. - Developed and maintained budgets and operating plans. - Ability to analyze trends, develop and maintain performance goals and regularly provide information to senior management. - Skilled in coaching, counseling and developing others to achieve operation objectives. - Skilled in team building, team participation, and achieving organizational success. - Excellent written, oral and interpersonal (negotiation and listening) communication skills. - Demonstrated experience working collaboratively with providers and executives, both inside and outside an organization. - Experience working with automated mainframe, personal computer, and business software applications. - Proficiency in Microsoft computer applications (i.e. Excel, PowerPoint and Access) and other job-related networks and software. - Basic knowledge of general business concepts including financial management organizational behavior and personnel/labor laws and regulations. - Insurance coverage, benefits and authorization requirements. - Payer specific requirements (e.g. workers compensation, managed care, commercial insurance, third party liability, Medicare, Medi-Cal, and other government programs). - Eligibility requirements for special circumstance coverage (e.g. Charity Care, Victims of Crimes, California Children Services). - Comprehensive knowledge of laws, rules, regulations, procedures and departmental policies relating to admissions and eligibility for reimbursement from Medi-Cal, Medicare and other public and private medical/financial assistance programs including Title 22 of California Administrative Code; basic principles of hospital administration. - Working knowledge of Medicare/Medi-Cal regulations, human resource management, EEO/AA laws, labor relations, statistical analysis, and customer service skills/techniques.