Under general supervision of the Manager of Pre-Access, the supervisor is responsible for the supervision of the daily operations of the revenue cycle and services associated with the Pre-Access Department. The supervisor leads and directs work assignments coordinating with other Billings Clinic departments and external providers to accommodate patient flow needs. The supervisor is responsible for leadership to all departmental staff and personnel management to include interviewing, hiring, orientation, training and creating-updating training manuals, performance appraisals, coaching, counseling, mentoring and disciplinary processes. Operations within the Pre-Access Department include support for the Pre-Access denial team, responsibility for one of the patient’s first impressions of Billings Clinic. Staff provide education both verbally and via mail to manage the patient and/or family member’s expectations as a patient of our facility. New and some established patients for hospital services will be contacted to obtain all patient and guarantor demographics, insurance information including any information related to accident insurance, etc. as well as emergency contact information. All regulatory requirements as to determination of primary, secondary, and tertiary carrier status will be collected. Staff will inform patient/family member of insurance billing processes as well as payment expectations. Payment policies will be reviewed as well as any need for co-payment and/or coinsurance/deposit requirements. Through the conversations during registration and demographic information collection, staff will provide patients with information regarding the need to contact Financial Representatives in reference to financial assistance and/or payment arrangements. Addresses will be verified electronically by staff members. Over sees and provides back up for insurance build and maintenance duties for entire facility and domain.

Essential Job Functions

• Interprets, supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service. Provides leadership for the staff within the Pre-Access Department who provide first impressions of Billings Clinic (both hospital and clinic) to patients and family members. Focus on patient service is first and foremost.
• Oversee Pre-Registration team– complete review of patient demographics and health plans for upcoming dates of service for hospital services.
• Oversee Pre-Certification team – submission for prior authorization notification and/or approval from payer for upcoming services. Submissions for related retro-auths as needed.
• Oversee Authorization team – submission of admit status for patients admitted after unscheduled admittance to hospital. Follow up of denial resubmissions when required.
• Coordinates with physician champion and clinical managers for optimal outcomes for benefit of patient and Billings Clinic in regard to workflows, authorizations, coordination between clinical needs and business needs, and successful challenges in regard to retro auths and denial work.
• Provides root cause analysis for denials and retro authorization opportunities.
• Supervises all aspects of the daily operation and staff in the Pre-Access Department. Responsible for personnel management to include interviewing, hiring, orientation, training and creating/updating training materials, performance appraisals, coaching/counseling, mentoring and disciplinary action up to and including discharge as coordinated with the manager and Human Resources. Demonstrates ability to motivate staff. Works towards balancing institutional initiatives with employee morale.
• Utilizes performance improvement principles to assess and improve quality. Takes initiative to monitor and assess processes to ensure effectiveness of employee efforts. Ensures quality assurance processes and weekly reports are completed and compiled in accordance with department guidelines and disseminated to appropriate individuals in a timely manner. Develops tools needed to achieve goals of less than 5% average error rate.
• Develops and implements written policies and procedures as necessary. Performs follow-up to ensure implementation is accurate and appropriate. Seeks appropriate input from areas affected prior to implementation, (i.e. Administration, etc). Communicates new policies and procedures effectively to achieve desired outcome. Monitors effectiveness.
• Demonstrates the ability to analyze patient and task volumes. Generates appropriate access reports to forecast staffing needs in the present and in the future. Maintains staffing within agreed upon budgetary guidelines.
• Develops appropriate training, tools, and classes to ensure new hires and existing staff keep their skills updated. Recognizes need for skill development in staff and follows up with appropriate training. Consistently delivers feedback and education to those identified as needing skill development. Provides educational opportunities to all staff levels to allow for growth.
• Assesses patient survey results. Analyzes outcomes and develops methods of improvement for areas with less then 75% of excellence. Works with appropriate department managers for successful outcomes.
• Coordinates monthly with customer areas, system-wide, to determine satisfaction with support of communications. Provides documented feedback to management.
• Develops a cohesive efficient team in each area and promotes teamwork system wide. Promotes objectives of an integrated health care system by developing global processes.
• Demonstrates professional/technical job competence relative to registration, admitting, bed placement and corresponding functions.
• Works as liaison between Pre-Access department and Financial Representatives, Hospital Business offices, Managed Care and branch area clinic coordinators to effectively capture and monitor defects in measured processes such as eligibility related denials, co-pay and deposit levels, new insurance requirements, etc.
• In conjunction with the Manager of Pre-Access, develops and maintains a budget consistent with goals and objectives of the organization.
• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.
• Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance. Maintains knowledge of emergency/disaster procedures and develops departmental processes to support those outlined in the Kardex.
• Performs other duties as assigned or needed to meet the needs of the department/organization.