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Company: MedStar Medical Group

Location: Washington, DC

Career Level: Mid-Senior Level

Industries: Not specified

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Description

General Summary of Position

The individual in this position is responsible for coordinating all the functions and activities related to patient access in the department including, but not limited to, front end customer service, accurate patient registration in the approved organization electronic scheduling and billing systems, on-site insurance verification and financial counseling, accurate Time-of-Service (TOS) payment collections, and the balancing of all TOS payments using the approved organization electronic scheduling and billing system Front Desk Module. The person in this position supervises and directs the maintenance and ongoing monitoring of the patient health record in department. The person in this position is responsible for directing, organizing, planning and supervising the activities of personnel engaged in Patient Service activities, including those related to all revenue cycle related activities. These functions are performed in accordance with Georgetown University Hospital's (GUH) philosophy, policies, procedures and standards.

Primary Duties and Responsibilities

Registration Process - Manages the entire patient registration process, including staff adherence with all established policies and procedures related to querying the Enterprise Access Directory (EAD) and obtaining complete demographic and insurance information for each patient appointment. Hires, regularly evaluates / mentors staff and counsels when appropriate. Ensures staffing is appropriate for clinic demand and makes recommendation to supervisor for staffing modifications as necessary.

Scheduling Process - Manages the entire patient appointment scheduling process, including staff adherence with all established policies and procedures related to determining and accurately documenting the appropriate appointment type, provider, referral and/or authorization requirements, procedure orders, and other appointment specific requirements.

Manages the scheduling of surgical cases, procedures and admissions for the Department, including staff adherence with GUH procedures and appropriate communication of GUH facilities, policies and instructions to patients and families.

Manages and directs implementation and maintenance of the approved organization electronic scheduling and billing system patient scheduler system, including triaging referrals and/or orders to appropriate physician for care. Performs or insures the performance of all master scheduling functions including development and maintenance of master schedules. Performs or insures the performance of daily scheduling edits as necessitated by provider schedule changes.

Patient Arrival / Check-in & Check-out Processes - Manages the patient check-in and check-out process for Department including patient reception, validation of patient identity, scanning of patient documents to the appropriate system, resolution of all alerts for missing or inaccurate information prior to patient arrival, insurance verification, collection and electronic posting of time of service (TOS) payments, appropriate and timely statusing of all appointments, collection and review of all encounter forms, daily deposit of TOS payments, and preparation of charge batches.

Monitors staff adherence to billing procedures and reports to the Department Administrator on daily activity and process improvement initiatives. Provides batch management oversight, including monitoring encounter form completion, reconciliation and batching processes of front-end billing practices to optimize charge capture and reimbursement.

Ensures compliance with all applicable Georgetown Physicians Group (GPG), GUH, department and internal audit policies and procedures. Ensures staff adherence to accurately review, follow up and complete the approved organization electronic scheduling and billing system standard and custom reports, including past pending, missing charge, charge lag and rejection reports. Recommends and implements corrective actions as appropriate.

Referrals, Pre-certification and Authorization Process - Manages the referral, pre-certification and authorization process for Department including staff adherence to all GPG, GUH and Managed Care Department requirements and contracts to ensure all patient appointments have required approvals in advance of the appointment.

Determines in conjunction with the provider if an appointment can be rescheduled if there is a missing referral, pre-certification, or authorization. Manages communications with insurance companies, patients and providers regarding eligibility verification, benefits and deductible status, and authorizations for office-based and Hospital services, procedures and admissions.

Ensures coordination with the Patient Financial Clearance Unit (PFCU) in obtaining any missing information for patient appointments. Manages documentation of referrals and authorizations in the approved organization electronic scheduling and billing systems. Ensures staff adherence to correct use of all applicable data fields in the Open Referral Module and on the Appointment Data Form (ADF).

Provides training and education of staff on managed care contracts and processes, system utilization of the approved organization electronic scheduling and billing system, Joint Commission (JC) standards, and Health Insurance Portability and Accountability Act (HIPAA) privacy guidelines and compliance issues.

Patient Health Records - Responsible for ensuring staff adherence to GPG, GUH and departmental policies and procedures for access to patient Medical Records / Electronic Health Records (MR/EHR). Supervises Scheduler, Front Desk, Administrative Support and Department Pre-certification / Authorization staff utilization of MR / EHR, ensuring protocols are followed. Monitors staff phone notes, prescription requests, and other EHR updates for timeliness and appropriateness.

Ensures that medical records meet departmental, managed care, Joint Commission, HIPAA and other regulatory standards. Implements and maintains system for consent/release of medical records. Coordinates internal chart audits and monitors chart activity, including complete patient intakes/dictations, problem lists and disposition notes.

Coordinates storage of files and maintains database for inactive patient charts. Oversees the technology initiatives, including EHR implementation projects and ongoing performance enhancements. Audits staff productivity and utilization of EHR and billing system, to include, indexing, scanning, phone notes, files in error and other appropriate measures of staff productivity. Addresses physician/patient issues and inquiries promptly and appropriately.

Provides resolution and follow up, as necessary, including written and verbal correspondence. Acts as liaison to the Physicians' Unified Billing Services (PUBS) and the PFCU for patient account and provider enrollment issues and the Managed Care Department for insurance plan matters.

Patient Satisfaction - Collaborates with health care team members, including physicians, social workers, residents and other clinicians, as well as Department Administrator to identify barriers to efficient, quality service. Participates in the development, implementation, and evaluation of measures to enhance services provided in the clinic. Assists Administrator with planning, developing, and implementing new policies and procedures for outpatient clinic. Responds to patient complaints and facilitates resolution of service breakdowns. Monitors patient satisfaction results, reviews with staff, and collaborates in process improvements.

Process Improvement - Actively participates in departmental and hospital meetings, such as Clinical Practice, Managed Care, Compliance, etc. Represents department at GUH & GPG User Meetings. Relays relevant information to front-desk staff, provides training and documents as appropriate, and completes required projects/assignments as relevant to specific program areas.

Participates in front-end clinic operations, including but not limited to answering phones, scheduling appointments, greeting and registering patients, collecting patient financial responsibilities, verifying benefits, confirming appointments, and communicating schedules with clinicians. Provides back-up coverage for clinic operations.

Exemplifies Guest and Staff Relations and exemplifies Commitment to Caring (C2C) Customer Service/Courtesy Behaviors in all activities - Greets every customer and coworker with a warm welcome. Smiles, makes eye contact, and always demonstrates a positive attitude with all customers and coworkers;

Performs other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all inclusive.

CUSTOM.PRIMARY.DUTIES.RESPONSIBILITIES.ADDENDUM

Minimum Qualifications
Education

Bachelor's degree Preferably in Health Care Management required

Experience

3-4 years' Experience in a customer service environment, including previous experience with computerized registration systems required
Medical/clinical office experience previous personnel management experience as well as financial management preferred

Knowledge, Skills, and Abilities

Working knowledge of IDX / GE Centricity Business preferred.
Previous experience with an electronic health record system desired, especially GE Centricity EHR or Aria.
Ability to perform in a high pressure environment and appropriately motivate staff.
Ability to organize and prioritize work.
Excellent interpersonal communication and customer service skills, and good telephone etiquette.
Knowledge of medical terminology, HMO/PPO insurances.
Effective oral and written communication skills.
Ability to deal effectively and professionally with a variety of different individuals.

This position has a hiring range of $70,428 - $131,310

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Patient Service Manager - Ambulatory Imaging (Breast Clinic) Job Listing at MedStar Medical Group in Washington, DC (Job ID req47511)

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Patient Service Manager - Ambulatory Imaging (Breast Clinic) Job Listing at MedStar Medical Group in Washington, DC (Job ID req47511)

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