Insurance Verification Scheduling Lead - Patient Access - Full Time/Days - Req#2185050908

Job Objective:

Under the supervision of the Department Supervisor, coordinates training of staff, to support hospital wide strategy. Provides support in organizing and controlling workflow to accomplish the objectives of the department and work flow standards.

Duties and Responsibilities:

A. Leadership

1. Leads by example and serves as a professional role model

2. Evaluates problems, and works in concert with the Department Supervisor and Admitting Director to implement solutions for improvement

3. Oversees completion of tasks by staff. Takes appropriate action when staff responsibilities are not being met by coaching, instructing

4. Demonstrates ability to make quick decisions when necessary

5. Understands and complies with accreditation and regulatory requirements and internal processes relating to regulatory compliance

6. Assist staff in the completion of daily job assignments and takes on case load when necessary

7. Evaluates and reassigns staff work load on a daily basis and when necessary

8. In the absence of the Supervisor and/or Director is able to provide supervision to coordinate the functions and activities of the Insurance Verification and scheduling departments.

B. Quality Control

1. Provides training to new staff and up-training to existing staff when changes are implemented

2. Reviews insurance verifications and scheduling slips for quality accuracy, corrects errors, documents and gives direction to staff to correct mistakes

3. Monitors staff productivity and reports back to the Department Supervisor with concerns

4. Documents errors for monthly error rate totals and provides feedback to the Supervisor and/or Director

C. Customer Service

1. Review and resolves patient/customer complaints

2. Ensures staff is following the customer services expectations

D. Scheduling Requirements

1. Takes the lead in covering for sick calls. Makes every effort to cover without creating over-time. Consults with Department Supervisor and/or Director when double time is involved

2. Utilizes flexing empowerment by flexing staff during low census periods at the direction of the Department Supervisor and/or Director

E. Management Information Systems

1. Understands departmental information systems and other equipment

2. Understands advanced aspects of various information systems

Non-Essential Duties:

· Participate in the daily duties of all areas of Registration workload as needed

· Other duties as assigned, within skill sets and abilities

· Accepts and carries out all other miscellaneous clerical and/or administrative duties and responsibilities as required for maintaining all services provided by Antelope Valley Hospital

Knowledge, Skills and Abilities:

Knowledge

· Knowledge of medical terminology

· Demonstrated technical knowledge of typical admissions and registrations, patient accounts and cashiering functions

· Demonstrated knowledge of The Joint Commission, DHS, CHA, EMTALA, NCQA, HCFA and Title 22 Regulations and requirements

· Working knowledge of third party payers, HMO, PPO, Commercial, and Workers’ Compensation reimbursement

· Working knowledge of Managed Care contract language

· Knowledge of basic arithmetic

· Knowledge of the use of a calculator

Skills

· Conflict management and resolution skills

· Problem-Solving skills

· Timely decision-making skills

· Demonstrated leadership abilities

· Basic personal computer skills to include Microsoft Office applications

· Proficient in the operation of scanners, copiers, and fax machines

Abilities

· Ability to handle stress

· Ability to manage a heavy caseload in an organized and efficient manner

· Ability to recommend appropriate account adjustment and write-off suggestions

· Ability to recognize potential accounts receivable related problems and offer solutions to management

· Ability to maintain a working relationship with other departments within the organization

· Ability to review all billing transactions for accuracy, discrepancies, and appropriate charges

· Ability to document account information at time of account follow-up

· Ability to run accounts receivable reports as needed

· Ability to motivate, coordinate and lead staff in daily operations and to ensure staff compliance with established facility goals

· Mediates personal problems and resolves complaints using good problem solving techniques.

· Demonstrates the ability to review and resolve patient complaints

AVMC Values: All AVMC employees will effectively demonstrate these values:

· Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.

· Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.

· Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.

· Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.

· Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.

· Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.

· Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.

Education and Experience:

Education

· High School graduate or equivalent required

Experience

· Recent experience in an Admitting Department in an acute care setting preferred. Will consider recent acute care hospital Business Office experience

· Two (2) years previous Commercial, HMO, PPO, and Workers Compensation billing and/or insurance follow-up/ insurance verification experience, required

· Three (3) years previous experience in acute care surgery/procedure scheduling required

Required Licensure and/or Certifications:

· None

AVMC Conduct/Compliance Expectations:

· Ability to adhere with AVMC Attendance and Punctuality Policy.

· Ability to adhere with AVMC Leaves of Absence Policy.

· Ability to adhere with AVMC Paid Time Off (PTO) Policy.

· Ability to adhere to the department dress code.

· Ability to organize work and establish priorities.

· Ability to expand on own initiative in performance of duties.

· Skill and ability to follow the telephone etiquette/standards.

· Ability to function effectively under pressure and meet time parameters.

· Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff.

· Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVMC.

· Ability to maintain the confidentiality of patient, hospital and department information.

· Ability to adhere to safety rules and regulations.

· Safely and effectively uses all equipment necessary to carry out duties.

· Ability to interpret and function under hospital and department policies and procedures.

· Conforms with required and appropriate accreditation and regulatory requirements.

· Conforms with and supports hospital quality assurance and improvement guidelines.

· Ability to participate effectively in department and hospital staff education.

· Display a willingness to work as a team player.

· Ability to give and support the highest level of patient/customer satisfaction at all times.

· Supports and adheres to the values and mission statement established by the AVMC Board of Directors.

· Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.

· Ability to follow the Code of Conduct.

Physical Requirements and Working Conditions:

· Primarily works in a climate-controlled area

· Frequent sitting and standing for long periods of time

· Tolerate repetitive arm and hand movements

Education and Experience:

Education

· High School graduate or equivalent required

Experience

· Recent experience in an Admitting Department in an acute care setting preferred. Will consider recent acute care hospital Business Office experience

· Two (2) years previous Commercial, HMO, PPO, and Workers Compensation billing and/or insurance follow-up/ insurance verification experience, required

· Three (3) years previous experience in acute care surgery/procedure scheduling required

Required Licensure and/or Certifications:

· None