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Primary Work Location

Turbine Drive Building

Department

RCH Revenue Cycle Management Services

Scheduled Weekly Hours

40

Job Summary

Under the oversight of Revenue Cycle leadership, the Manager of Financial Clearance is responsible for the direction and leadership of operational, financial, and personnel activities of the Pre-Arrival Management. The Revenue Cycle Manager of Financial Clearance will maintain the organizational policies and strategies ensuring a consistent, and exceptional Pre-Arrival patient financial journey in accordance with national standards, regulatory requirements, and accepted best practices. This leader serves as a change agent while promoting a culture of innovation and service excellence.

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

*Supportive work culture

*Medical, Vision and Dental Coverage

*Retirement Plans, Health Savings Account, and Flexible Spending Account

*Instant pay is available for qualifying positions

*Paid Time Off Accrual Bank

*Opportunities for growth and advancement

*Tuition assistance/reimbursement

*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)

*Flexible scheduling

Job Description

Essential Functions:

• Manages and collaborates with key Monument Health stakeholders to direct the planning, design, and coordination of the workflows of Pre-Arrival patient financial management functions within the Revenue Cycle. These functions may include but are not limited to Financial Clearance (Pre-Registration, Pre-Arrival Insurance Benefit Management, and Authorization/Benefit Review ); Patient Admission/Registration Support (Inpatient and Outpatient Registration, ED Registration, Insurance verification); Financial Counseling (Price Estimations, Fund Finding and Resource eligibility, Charity Care Review); Customer Service (Patient collections, Customer service follow-up, and patient balance resolution), and communicate with Revenue Cycle vendors associated with the work units
• Promotes a just and safe culture through the encouragement of accountability, teamwork, collaboration, and operational excellence in holding with organization mission, vision, priorities, and values.
• Monitors the processes and environment of admissions and registration support and financial clearance to ensure a patient centered experience is consistently provided, with an emphasis on the patient’s financial wellness and organizational fiscal responsibility.
• Manages department quality improvement initiatives by identifying problem areas and developing plans of action to ensure benchmark standards are obtained and maintained by providing feedback, suggestions, and continuous improvement recommendations to Revenue Cycle leadership.
• Maintains a detailed knowledge of the components of Pre-Arrival patient financial management including patient estimates, resource and fund finding, charity assistance, health insurance and benefits, standard billing practices.
• Understands how Pre-Arrival patient financial management impacts the flow of work throughout the departments and organization. Acts as a liaison for both internal and external customers to inform Pre-Arrival patient financial management and financial clearance processes to aid in the completion of the encompassed Revenue Cycle workflows from scheduling of care through the claims submission and resolution processes.
• Demonstrates a knowledge of core revenue cycle functions such as billing, claims filing, data entry, charge entry and capture, insurance follow up, denial management, payment posting, customer service, and billing records review to support all duties related to preservice financial clearance and resolution of related denials.
• Maintains a thorough knowledge of industry and third-party reimbursement regulations and system software. Interprets these rules/regulations/requirements for all Monument Health caregivers and leadership.
• Analyzes, assists, and resolves problem claims through the management of follow up and denial work queues for areas of responsibility. Demonstrates an understanding of technical denial areas, such as: medical necessity, eligibility issues, coding issues, no authorization, and timely processing of claims.
• Ensures the Pre-Arrival patient financial management and related financial clearance process for areas of responsibility is completed timely and accurately prior to patient arrival by gathering and analyzing departmental and program specific financial, productivity, and quality of service statistics.
• Provides escalated internal and external customer support service.
• Establishes and provides on-going monitoring of annual strategic goals and actively uses benchmarking to high performing systems to set annual targets.
• Actively participates in payer and/or departmental meetings as well as enterprise-wide committees and workgroups to facilitate interdepartmental activities addressing issues with a broad scope of concerns and impacts for Monument Health.
• Responsible for all hiring and related personnel decisions, completing routine performance review evaluations, training, scheduling, and process documentation in collaboration with other leadership.
• Meets regularly with direct reports to review accomplishments and set goals. Provides opportunities to aspiring leaders to develop skillsets to meet career goals.

• Provides information for budget preparation and assists with achieving organizational financial goals by maintaining fiscally responsible decision making.

• All other duties as assigned.

Additional Requirements

Required:

Education - High School Diploma/GED Equivalent

Certification - Certified Healthcare Access Management (CHAM) - National Association Healthcare Access Management (NAHAM) within one year of hire

Certification - Lean Six Sigma or Monument Health Yellow or Green Belt within one year of hire

Experience - 3+ years of healthcare business office or related support services, 1+ year in a leadership position of supervisory level or higher requiring daily, direct staffing oversight

Preferred:

Education - Bachelor’s degree in a Healthcare, Business, or related field

Experience - 3+ years of A Revenue Cycle Healthcare support services

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Revenue Cycle

Job Family

Patient Financial Counseling

Shift

Employee Type

Regular

10 Monument Health Rapid City Hospital, Inc.

Make a difference.  Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.