Director, Care Connections Access at University Hospitals, United States-Ohio-Shaker_Heights

Director, Care Connections Access at University Hospitals in United States-Ohio-Shaker_Heights. Contract. Est. up to $160k. Apply with swipeandhired.

A Brief Overview The Director of Care Connections Access is a senior leadership role responsible for directing and overseeing patient access operations across their designated market, including registration, scheduling, authorization, financial clearance, and point-of-service collections. This role ensures the Leadership Rhythm of Accountability is followed by all direct reports, leads initiatives to decrease bad debt and denials while increasing cash flow for the organization, and partners closely with the leadership of each hospital in their market of oversight to advance shared goals.The Director safeguards regulatory compliance, including IMM, MOON, and MSPQ requirements, champions successful point-of-service scheduling in the Emergency Department, and drives retention and engagement strategies for their teams. The successful completion of duties performed by this position directly impacts the quality of the patient's account, including timely and appropriate processing of clinical and financial services, prevention of denials, customer satisfaction, and reduction of bad debt.This role serves as the market's subject matter expert and primary escalation point for the most complex patient access, registration, authorization, and payer-related issues. The Director leads/owns internal and external audits directly related to Patient Access and/or acts in a support role where Patient Access is a stakeholder, utilizes effective communication skills in patient/physician relations, and maintains current understanding of governmental and payer requirements, employee engagement, training, reporting, and use of multiple, complex systems.
What You Will Do

• Leadership & Accountability
• Ensures the Leadership Rhythm of Accountability is followed by all direct reports, including consistent meeting cadence, reporting, and follow-through on action items
• Directly oversees leaders and staff members and is responsible for ensuring department productivity standards are met/exceeded
• Responsible for all personnel hiring, coaching, and evaluating by completing routine performance reviews regarding expectations, performance, and compliance of policies and procedures
• Leads retention and engagement strategies to strengthen team stability, satisfaction, and performance
• Performs duties to promote a positive work environment and leads activities to increase engagement within the department
• Provides on call support (24/7) to department leaders to ensure staffing levels are maintained
• Processes payroll and approves time off requests for direct reports
• Financial Performance & Revenue Cycle
• Leads initiatives to decrease bad debt, decrease denials, and increase cash flow for the organization
• Ensures successful point-of-service collections, patient estimates, and patient out-of-pocket responsibilities are consistently followed across all applicable areas
• Accountable for the successful execution of patient estimates, education to guarantor regarding charges and out-of-pocket liability, and establishing payment plans when applicable for professional and technical services
• Accountable for the successful pre/point of service cash collection practices completed by direct reports; meeting established goals and benchmarks and enforcing collection guidelines for individual productivity measures
• Analyzes unbilled trends to identify people, process, and/or technology resolutions to permanently resolve issues; ensures daily unbilled is monitored to ensure timely disposition of encounters (or accounts)
• Inspires staff to ensure daily cash collection, authorization, and eligibility goals are met or exceeded; provides transparency and holds each staff member accountable for successful collections
• Market & Facility Partnership
• Works with the leaders of each hospital in their appropriate market of oversight, providing regular updates on new initiatives and the progress of current initiatives
• Collaborates with facility leadership to ensure each hospital in the market achieves successful outcomes across Patient Access functions
• Ownership of the eligibility, authorization, and pre/point of service collection processes at designated facilities and/or service lines within the market
• Emergency Department & Regulatory Compliance
• Responsible for successful point-of-service scheduling in the Emergency Department
• Ensures compliance with IMM, MOON, and MSPQ regulatory requirements across all applicable areas
• Accountable for the verification of medical necessity and execution of patient education and acknowledgment of covered and non-covered services
• Oversight of the authorization for services workflow, including escalation, payer requirements, and proactive monitoring and productivity to ensure services have authorization before their date of service
• Access Operations & Continuous Improvement
• Facilitates and manages Revenue Cycle functions in Access including but not limited to eligibility, authorizations, medical necessity, cash collections, denial management, account resolution activities, quality measures, and other UH initiatives
• Oversight of the patient interview (face-to-face/phone/via document) and utilization of multiple complex applications to create (or validate existing) patient medical records and insurance/bill claims using demographic and insurance information
• Mastery of skills relating to insurance coverage, benefits, rules & regulations, and allocation of plans, ensuring accurate information and fulfillment of requirements resulting in expected payment for services
• Accountable for the verification and allocation of insurance plans utilizing electronic eligibility tools, phone calls to payers, and web portals, initiating appropriate action for services including non-covered and out-of-network insurance services
• Ensures achievement of registration quality for direct and indirect areas performing the function
• Leads entity programs/initiatives that have direct impact to registration/pre-registration, ensuring appropriate process, training, and outcomes are achieved
• Performs other analysis of department workflow, outcomes, and trends to identify and pursue continuous process improvement
• Continues to identify modern approaches to pre-registration and registration processes to optimize access, communication, and experience
• Plans, organizes, and executes Revenue Cycle Management and process improvement initiatives
• Analyzes and reports out metrics related to Revenue Cycle Access Services and/or Revenue Cycle Management
• Works with Finance, Payers, and Managed Care on eligibility strategy and pre-authorization determination denials
• Leads workflow efforts for assigned areas, analyzing, reassigning, and adjusting based on work needs
• Utilizes electronic reports, worklists, and queues to identify claims requiring updates; makes corrections as needed to ensure accurate and timely billing
• Ensures staff have the tools, access, and training needed to successfully meet individual and department key performance indicators, benchmarks, and patient experience metrics
• Creates reports and dashboards to measure Key Performance Indicators
• Assists with evaluation, testing, and reporting of IT systems in relation to upgrades, code changes, and process improvements, including working closely with IT, other system owners, and vendors
• Compliance & Standards
• Creates and monitors departmental budgets, governmental and regulatory compliance, departmental contracts, and vendor relations Writes and ensures understanding of and adherence to policies and standard operating procedures
• Ensures staff are compliant and complete required education as established by the department and the UH enterprise
• Responsible for the education and compliance of emergency management procedures for staff/patient tracking and safety
• Maintains strict confidentiality and safeguards Protected Health Information (PHI) in accordance with regulatory requirements and organizational policies

Additional Responsibilities

• Leads/owns internal and external audits directly related to Patient Access and/or acts in a support role where Patient Access is a stakeholder
• Must be dependable to work in this 24/7/365 department with willingness to travel to other sites and locations throughout the enterprise, including possible overtime
• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.