PATIENT ACCESS MANAGER

Description

The Patient Access Manager (PAM) is responsible for the coordination and supervision of Patient Access staff at the Gila Regional Medical Center (GRMC). This individual aids in setting goals, priorities, and performance standards for Patient Access functions at GRMC including: Centralized Scheduling, pre-registration/registration for Inpatient/Outpatient, insurance verification, prior authorization, financial clearance, admission, and switchboard operations. The Patient Access Manager must have an understanding of how these areas impact the flow of work through GRMC and the revenue cycle. 

Duties include guidance and coverage of employees, monitoring of Quality Assurance measures, and oversight in ongoing staff training. 

The goal of this position is to ensure high Quality Service for patient’s and accuracy of information affecting both pre and post visit services.

This individual will be involved in departmental and interdepartmental process improvement teams to eliminate waste and improve efficiency. The position requires the ability to independently plan, schedule, organize and respond appropriately on a wide variety of subjects and situations. The ability to perform the duties of the Patient Access staff supervised is required.  As hospital reimbursement is dependent upon the activities of the patient access functions, timely completion of duties and follow-up is critical. 

Requirements

ESSENTIAL FUNCTIONS:

 Management

• Develop staffing calendars and assure staffing needs are met. Implement alternative staffing patterns as needs arise, taking into consideration department budgetary constraints and performance requirements and restrictions. 
• Interview and make hiring decisions to maintain adequate staffing in the department. 
• Review and process time cards in an accurate and timely manner.  Maintain accurate employee attendance files.
• Involve Patient Access Staff in solution finding and decision-making.
• Encourage and commend Patient Access Staff for excellent performance.  
• Provide timely performance improvement feedback and coaching.   Discipline staff when warranted by inappropriate employee behavior or inadequate work performance.
• Conduct timely training assessments, reclassification exams, and performance reviews.  Solicit feedback from other staff and other as appropriate.
• Respond to employee questions/concerns on an individual basis as needed. 
• Conduct team meetings to apprise associates of changes and to address broader-based program area issues and initiatives.
• Ensures proper utilization of all Hospital and Patient Access software 

Development and implementation of policies and procedures

• Develop, recommend and implement policies and procedures for the department, focusing on continuous process improvement and waste elimination.
• Monitor all Patient Access processes in adherence to policies and established procedures. Propose methods which assure effective execution of program responsibilities.
• Update policy and procedure manuals as required. Apprise associates of changes.

Operational Duties

• Create and implement methodologies to improve and measure the patient experience.  Ensure that patient experience and service standards are met.
• Use reports and dashboards to monitor the daily productivity of the Patient Access department and Patient Access Representatives.  
• Assist each area with meeting operational key performance indicators and industry benchmarks.
• Produce reports, monitor work queues, and provide recommendations for improvement in patient access to ensure patient information is complete and accurate for billing and clinical purposes.
• Monitors OR and Radiology Scheduling performance and interaction with Patient’s, Departments, and Physician’s offices to ensure accuracy, Quality Assurance, adherence to processes/policy/procedure and appropriateness
• Gather and analyze departmental and program specific productivity and quality of service statistics.  Ensure quality audits are regularly performed to promote quality and identify root causes of issues.
• Work collaboratively with Clinic Managers, Appointment Center, Patient Access, Patient Financial Services, and other GRMC departments on issues relating to patient scheduling, registration, admission, insurance verification, referrals and reimbursement issues. Represent the department in meetings and on committees relating to these issues. 
• Serve as the acknowledged expert and information source for staff.  Keep abreast of scheduling, insurance, referral, and billing requirements.  Request system enhancements as needed to facilitate accurate scheduling and registration.
• Serve as an escalation point for patient issues and questions.  Assist associates with complex and disgruntled patient situations requiring intervention from a higher authority.
• Participate in process improvement teams as assigned.
• Assist with application implementation, upgrades, enhancements, and usability testing.
• Assure equipment is in working order. Recommend the purchase of new equipment as required.
• Monitor departmental budget and assists in projecting monthly/annual expenditures.
• Ensure awareness, understanding, and compliance with all applicable federal, state, and agency laws and regulations.
• Other duties as assigned.

Training

• Oversee the education of Patient Access Staff, including new employee orientation, competency assessments, and ongoing education programs across all areas of responsibility.
• Keep accurate records of personnel training schedules as well as training checklists.
• Train and delegate appropriate training responsibilities for new and current associates. Schedule and facilitate cross-training of associates.
• Observe and modify training schedules as needed to include new methodologies and concepts. Conduct training review sessions.
• Actively seek and schedule Patient Access staff development opportunities, including those outside the department that would be beneficial for staff members to attend.
• Monitor trainee progress and trainer effectiveness via regular meetings.
• Identify focus areas for competency assessments. Provide training opportunities addressing areas highlighted by these assessments.
• Participate in training/development programs as agreed upon with the Access Services leadership.

EDUCATION & TRAINING REQUIREMENTS:

· Minimum High School Diploma or GED

· Minimum of 2 years of Leadership in registration, insurance verification, and scheduling experience, health education, patient   navigation, and/or health clinic patient assistance field preferred. 

· Intermediate experience with MS Word, MS Excel, MS Outlook. 

· Knowledge of CPT and ICD-10 Codes. 

· Strong understanding of benefits investigating; deductibles, co-insurance, out of pocket expense & benefit exclusions. 

· Ability to effectively handle multiple responsibilities simultaneously in a deadline driven environment.