Patient Financial Services Manager
Manager of Patient Financial Services
Summary: The PFS Manager oversees the output and quality of all back-end business functions, and collaborates with the Director of Revenue Cycle to identify strategies for performance improvement on a monthly basis. The PFS Manager is ultimately responsible for much of Tahoe Forest Hospital District's financial health as the staff he/she supervises and their associated functions play a large role in reimbursement, cash flow, and whether a patient will return for service to restart the revenue cycle process. The PFS Manager has primary responsibility for ensuring timely billing and collections on accounts receivables.
Essential Duties And Responsibilities: Manages and monitors the performance of PFS staff members, motivating them to work quickly and with precision. Supervises PFS personnel in the timely completion of all essential functions including billing, collections, cash posting, accounts receivable, medical records, etc. Monitors quality and productivity levels for both individual staff members and the team as a whole; identifies and re-trains underperforming staff members as needed. Ensures all staff provides exemplary customer service to both internal and external customers. Works with other department leaders to create reports regularly. Monitors Accounts Receivable and makes improvements for claim billing and follow up. Helps plan initiatives to increase performance as needed. Provides formal and informal communication and distributes education and information to the team as needed. Measures and compares key performance indicators; responsible to ensure district is meeting industry benchmarks. Responsible to be a knowledge resource related to workflow operations and the inner workings of the Health Information System (HIS), so as to recommend streamlined workflow resolutions as appropriate. Launches new reimbursement and collection initiatives with staff on regular basis, brainstorms methods for achieving them, and carries projects through until goals are successfully achieved. Ensures timely billing and proactively investigates and addresses potential billing process inefficiencies. Manages volume of billing workload and adjusts biller assignments as needed to maintain Accounts Receivable inventory and cash collections. Extracts and prepares data as requested. Ensures all billing and collection activities are compliant with federal, state, and industry standards and regulations. Prepares reports for monthly meetings, conducts audits and provides analysis of billing reports to ensure assigned Division's productivity, efficiency and financial goals are being met. Communicates with the Revenue Cycle Director, other departments' leaders, insurance carriers, patients, providers and/or other billing personnel to ensure a smooth workflow. Analyzes data and prepares reports on collections performance, governmental and commercial payer reimbursement, payment arrangements, etc. as required and/or requested. Manages the root-cause analysis of the designated initiatives that prevent timely billing or collection of accounts assigned to each team member and assimilate the data into readable and useful tools for analysis. Participates and collaborates with the Revenue Cycle Director for making effective recommendations to the larger Revenue Cycle team, leading to effective resolutions. Works in collaboration with all departments and units in the revenue cycle to appropriately communicate issues and/or barriers, and to formulate work plans for resolution of trended issues. Develops staff training materials and competency monitoring for all associated Patient Financial Services functions, including billing, follow up, cash collections, cash posting, denials management, customer service follow up, and so forth. Reports performance results to the Director. Assures uniformity in billing and follow-up approaches. Performs other duties as assigned by the Revenue Cycle Director. Demonstrates System Values in performance and behavior. Complies with System policies and procedures. Other duties as may be assigned.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Supervisory Responsibilities: The Manager of Patient Financial services is responsible to carry out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include (but may not be limited to): interviewing, hiring and training employees, planning, assigning and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving root causes of issues.
Education And Experience: High school diploma or general education degree (GED) is required, bachelor's degree preferred, but may be substituted with at least three years of related experience in a management position. Two years' experience in a healthcare commercial insurance billing environment, including knowledge of claims edit software or Electronic Data Interchange (EDI) is required. Two years' experience with a computerized admission, billing, and/or collection health information system is required. Knowledge of third party payers including managed care, Medicare, Medicaid, and Workers Comp is highly desirable. Knowledge of Medicare compliance, fraud and abuse principles, and third party payment practices is highly desirable.
Licenses, Certifications: Required: None Preferred: None
Other Experience/Qualifications:
Computer/Business Skills: Ability to use office tools and equipment, including proficiency with use of Microsoft Office programs such as Microsoft Word, Outlook, and Excel. Knowledge and experience with Electronic Data Interchange (EDI) processing procedures is highly desirable.
Language Skills: Ability to read, analyze, and interpret complex documents, including contracts and government regulation reference materials. Must possess the ability to respond effectively to patient sensitive inquiries and complaints, including written and verbal communication. Must have the ability to speak clearly and establish rapport with patients, while dealing with patients' sensitive medical and financial information. Must have the ability to explain complex concepts, such as insurance eligibility, benefit coverage and limitations, and copayments / coinsurance with a high degree of accuracy and clarity. Establish rapport with customer service personnel in the health plans. When dealing with both patients and insurers, must be firm and assertive in requesting action, but always maintain a professional demeanor. Written communication skills must include the ability to draft routine correspondence. Must be able to de-escalate confrontational situations in which the patient is angry about insurance or medical bills. Must be able to read and interpret policies and procedures. Must be able to de-escalate confrontational situations between employees.
Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of mathematics. Ability to apply concepts such as fractions, percentages, rations, and proportions to practical situations.
Purpose of Contacts: The purpose is to influence, motivate, interview, or control persons or groups. Employee must be skillful in approaching the individual or group in order to obtain the desired effect.
Reasoning Skills: Position must have the ability to deal with complex insurance billing requirements which vary from one insurance plan to the next. Must be able to troubleshoot problems with a particular bill and determine the appropriate action to take. Requires the ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Requires the ability to deal with problems involving several concrete variables in standardized situations.
About Tahoe Forest Health System
Joseph family created a legacy that would benefit our community for generations to follow. The community quickly rallied around the Joseph's donation of land for a new hospital. Sixty-six years later, Tahoe Forest Health System continues to thrive under this heritage of philanthropy. Through continued generous community support, Tahoe Forest Health System is able to offer a wide variety of high-quality programs and services. Tahoe Forest Hospital offers 24-hour emergency care, an ambulatory surgery center, intensive care, orthopedics and sports medicine, a medical/surgical unit, women and family center, home health and hospice programs, a health clinic, cancer center, long term care center, children's center, a health and sports performance center, as well as a variety of community health outreach programs. Tahoe Forest Hospital is a not-for-profit rural health care facility and designated critical access hospital. It is fully accredited by the Healthcare Accreditation Facilities Program and licensed by the State of California Department of Health Services. Tahoe Forest Hospital has 25 acute care beds and 36 long-term care beds. Our service area covers six rural counties, two states and approximately 3,500 square miles, reaching the communities of Truckee, North Lake Tahoe, Donner Summit, the Sierra Valley in California, and Incline Village in Nevada. A vital resource of Tahoe Forest Health System is Incline Village Community Hospital located in Incline Village, Nevada, and serving North Lake Tahoe, Kings Beach, Crystal Bay and Incline Village. It is a 4-bed critical access hospital offering 24-hour emergency care as well as laboratory, diagnostic and surgical capability, physical therapy services, health clinic and a sleep disorder center.
We are an Equal Employment Opportunity (EEO) employer and does not discriminate on the basis of race, color, national origin, religion, gender, age, veteran status, political affiliation, sexual orientation, marital status or disability (in compliance with the Americans with Disabilities Act) with respect to employment opportunities.