Under direction of the Ambulatory Director of Operations, the Financial Access Manager is responsible for daily operations and smooth coordination of patient referral information within the Centralized Financial Access unit while supporting the Spaulding Rehabilitation Network (SRN) admissions financial clearance process for patients referred from multiple sources. Responsible for smooth coordination of workflows including insurance verification, prior authorization, rate negotiations and work queue management. Manager acts as knowledgeable resource and problem-solver for the Patient Service Representative, Medical Service Representatives, and Financial Access Specialist in the ambulatory insurance authorization group. Responsible for the staffing and management of daily activities to produce successful outcomes of all patient admission encounters.

The Manager integrates department's services with the hospital's primary functions to facilitate ease of access to services provided by facility, develops/implements policies and procedures that guide or support services, and assesses and improves department performance. Addresses and initiates process improvements and new workflow management within the SRN Financial Access team. The Financial Access Manager is responsible for acting as a technical epic resource and super-user, assisting front and back-end departments involved throughout Revenue Cycle Operations (RCO). Manager effectively provides leadership, guidance, support, direction, focus, coaching and performance management for staff, escalation of workflow issues, addresses staffing concerns and flags patients identified as financial risks requiring immediate escalation to Sr. Leadership for timely resolution.

Responsibilities:

• Use/s the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

• Interview, hire, evaluate, and counsel PRS and MSR financial access staff and perform evaluations in timely manner. Supervise and train new employees in all aspects of assigned jobs and maintain productivity. Provide leadership needed to promote a teamwork environment and ensure orientation and continuing education of staff. Communicate changes to existing employees. Create training materials and manage on-line access and admin capabilities to all online and information systems being utilized.

• Ensure smooth daily department operations. Ability to make independent decisions when necessary to financially clear patients for services without escalating to Ambulatory Director of Operations in order to prevent further delays of services.

Collaborates with Ambulatory Director of Operations during candidate selection process including interviewing and hiring. Evaluates and provides feedback to Financial Access staff and completes and reviews performance appraisals and goal setting in a timely manner. Completes corrective actions as needed and counsels' staff for ongoing performance management. Supervise and train new employees in all aspects of assigned jobs and maintain productivity. Provide leadership needed to promote a teamwork environment and ensure orientation and continuing education of staff.

• Work closely with SRN leadership to coordinate financial clearance process for ambulatory patients referred to SRN -Spaulding Rehabilitation Charlestown (SRH), Spaulding Cape Cod (SCC), and Spaulding Hospital for Continuing Medical Care at Cambridge (SHC). Notify sites of financial issues that may impact decision to accept patient. Monitor prioritization of insurance clearance to facilitate an expedient referral process. Escalate to payers and delegate duties, as necessary. Maximize timely and efficient completion to reduce delays in filing deadlines.

• Responsible for promoting positive customer service and developing and maintaining positive relationships with referral sources and managed care companies. Responsible for promoting positive customer service with patients and families and ensure benefit and authorization related questions are answered when calls received, or calls are redirected to FAS by SRN Admitting Offices.

• Act as point person for SRN Ambulatory sites on insurance coverage changes, coordination of benefit (COB) issues, and re-verification of benefits. Assist with adding coverage and reaching out to the appropriate Central Billing Office (CBO) contact when ambulatory FAS staff unable to add new coverage when accounts are interim-billed or billed.

• Act as point person for FAS staff, SRN ambulatory sites for Epic technical issues and questions pertaining to Financial Clearance process, as well as general epic questions, some of which may require immediate attention and resolution due to Epic hard-stops and Admitting Offices being unable to admit the patient after patient has arrived.

• Communicate process and workflow changes to existing employees and other departments directly impacted. Create training materials and tip-sheets for Financial Access Department when new processes or programs are utilized, set up team meeting walk-throughs and trainings as needed, and provide ongoing support once implemented. Manage on-line access and administrator capabilities to all online portals and information systems being utilized.

• Understand specifics and nuances of each insurance contract's admission procedures to assure payment for post-acute stay. Take independent action to ensure all information obtained by access team is complete and benefit levels are adequate to ensure reimbursement for the care provided. Monitor patient registration function to ensure wait times are minimal.

• Review all workers compensation (WC) and non-contracted payer single case agreement (SCA) letters for SRH, SHC, and SCC to ensure proper estimate totals and wording before FAS submits to WC or non-contracted payer adjusters. Negotiate rates or a percentage of total billed charges with WC or non-contracted payer adjusters as needed.

• Contribute to A/R goals for patient registration and understands the revenue cycle. Work collaboratively with Central Billing Office (CBO) and Legal Counsel with appeals and retro-authorizations for accounts with authorization related claim denials. Follow-up on documentation/billing complaints promptly. Assist department in maintaining accurate electronic and other documentation tools utilized to research payer denials as needed to assure regulatory compliance.

• As the technical super-user, responsible for oversight and maintenance of patient, account and claim edit work queues as they apply to the SRN Dashboard Functions in conjunction with DNBs, stop bills and billing indicators. The Manager will participate in epic workgroups to discuss need for new functionality / build and client accounts. Act as point person for the MGB Revenue director for special high dollar amount accounts with authorization related issue

• Review and complete SRN Patient Access accounts on weekly "SCC, SRH, SHC DNB/Claim Edit Accounts Approaching Filing Limit" email sent out by CBO Business Analyst in a timely fashion to prevent accounts from reaching Timely Filing Limit.

• Work closely with eCare team as Financial Access subject matter expert (SME) to automate manual workflows and maximize full functions of Epic workflows to ensure consistency throughout the MGB Patient Access space and answer any Financial Access related questions as they pertain to eCare Team's needs or recommendations.

• Prepare and approve weekly staff timecards in UKG timely. Complete monthly work schedules as needed to ensure adequate staffing levels. Monitor PTO requests and manage summer vacation, Holiday, and weekend coverage. Develop, assign, and distribute daily FAS Coverage Plans when staff are out or off to ensure proper coverage across SRN sites for that given day with the staff available.

• Conduct monthly staff meetings and in-services for all responsible areas. Attend enterprise-wide patient access councils on behalf of SRN and communicate workflow and policy changes to the team.

• Responsible for transitioning centralized Financial Access Team to a remote workplace setting. Point person for ongoing remote technical needs including Jabber, Biscom E-fax, equipment ordering, and other programs as needed. Maintains workflows and adjusts appropriately as they pertain to remote Financial Clearance.

• Mandatory Trainings and/or Educational Professional Development Seminars per discretion of Financial Access Director.

• Places orders through PeopleSoft for all department supplies and orders for purchasing and outside vendors.

• Other duties as assigned by Ambulatory Director of Operation

Qualifications

• Bachelor's degree required. Master's Degree preferred

• Master's Degree in Specialty Health Field, Business or Healthcare Administration preferred

• Minimum two years of management experience preferred

• Experience in hospital Admissions, registration or revenue cycle preferred

• Experience with medical terminology and hospital ADT epic system preferred

• Knowledge of insurance plan's requirements and procedures required

Skills/Abilities/Competency

• Organization - proactively prioritizes needs and effectively manages resource

• Communication - communicates clearly and concisely. Excellent oral and written communication skills. Ability to communicate and collaborate well with patients, referral sources and the general public; able to respond professionally to difficult phone calls or situation

• Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality service

• Ability to work in an independent manner using excellent judgment in a fast paced and flexible environment as the work environment at times can be pressured and stressful. Holds ability to manage multiple tasks simultaneously

• Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems. Knowledge of governmental, federal, state, and local regulations related to admission

• Fiscal management - applies tools and processes to successfully manage to budget

• Critical thinking skills - must be capable of analyzing situations, prioritizing multiple tasks, re-prioritizing, making decisions under pressure and meeting tight deadlines in a demanding environment

• PC skills - demonstrates proficiency in Microsoft Office applications and others as required

• Must be cooperative, flexible, and adaptable to change to meet department goals, mission, and changes in the healthcare marketplace

• Must have positive attitude towards working in a team environment and always take the initiative to help others as needed.

Supervisory Responsibilities:

10-15 FTE direct report

Financial Responsibility:

• Ensure department stays within annual's budgetary responsibility

• Understands fiscal responsibilities and importance to detail as it relates to reimbursement

• Demonstrates fiscal responsibility by effectively using Mass General Brigham resource