AdventHealth Maitland seeks to hire a Director - Pre Access who will embrace our mission to extend the healing ministry of Christ.
Established in 1908, AdventHealth is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The 2,675-bed acute-care medical facility, comprised of nine hospitals, has been recognized by U.S. News & World Report as one of the best hospitals in the country for over 10 years. It serves as a community hospital for Greater Orlando and as a major tertiary referral hospital for Central Florida and much of the Southeast, the Caribbean and Latin America.
Actively manages all areas of responsibility within the Pre-Access Department (pre-registration, insurance verification and liaison with central scheduling) and maintains ongoing communication with system and campus leadership. Strategically designs the Pre-Access process to meet or exceed key performance indicators related to both financial metrics and regulatory compliance requirements. Emphasis is placed on providing a seamless registration process from scheduling, pre-registration, insurance verification, pre-certification, financial counseling and pre-collection of patient responsibility. Creates synergies, maintains bidirectional communication, and acts as liaison between Pre-Access and clinical and administrative partners within the hospital setting and beyond, ensuring open communication and collaboration toward common goals. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Proactively engages in problem resolution for patients, physicians, administration, and other internal or external customers including serving as a campus liaison to facilitate discussions and questions regarding the financial clearance process. Focuses on process improvement strategies with special focus on up-front cash collection outcomes to protect financial standing of AdventHealth. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies
Secures business results in the area of AH Extending Excellence model (Team, Clinical, Service, Market, Finance)
Inspires high performance and fosters a climate of collaboration and continuous learning
Initiates creative approaches to solving problems, or tapping potential and coaches effectively
Attempts to model balance in both life and work
Strong organization skills and excellent analytical and problem-solving skills.
Ability to work in a matrix-management environment to achieve organizational goals
Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff
Effective computer skills, particularly Microsoft Office Outlook, Word, Excel, PowerPoint and Internet Explorer
Maintain a detail level working knowledge of Governmental, State and Federal regulations and requirements. This includes maintaining a current knowledge and understanding of the following organizations, publications, bulletins and memorandums: Medicare Part A & B, Agency for Health Care Administration, Federal Register HCFA Notices and Updates, State of Florida Medicaid Program, Fair Debt & Collection Act Consumer Credit Act, Hospital HMO/PPO Contractual authorization/pre-certification guidelines/requirements.
Working knowledge of Microsoft PowerPoint (Preferred)
Working intermediate knowledge of Microsoft Excel (Preferred)
Working intermediate knowledge of patient accounting systems as well as back-end and front-end revenue cycle functions and processes (Preferred)
Minimum BS in Business Administration (or equivalent), Health Services Administration, Hospitality Administration
Preferred MBA, CMPA, or CPAM (Preferred)
Minimum ten (10) years' experience in Patient Access Department (central scheduling, insurance verification, financial clearance and pre-registration area) or related area, including seven (7) years' experience in leadership role.
Licensure, Certification, or Registration Required:
Demonstrates through behavior AdventHealth's Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization's Performance Excellence Program.
SCOPE OF RESPONSIBILITY:
Strategically designs the Pre-Access process to meet or exceed key performance indicators related to both financial metrics and regulatory compliance requirements.
Practices excellent time management in order to be available to attend meetings for administrators of all responsibilities.
Innovates, initiates, implements, investigates and responds to change and opportunity with agility. Actively seek new and improved ways to increase productivity.
Participates and collaborates with Leadership staff and fellow Directors to continuously raise the level of service provided by staff to all of the hospital's customers.
Assures that all departmental staff efforts are organized for maximum efficiency, control and productivity, training and cross-training of personnel.
Develops and assigns realistic and innovative performance goals, providing ongoing reports, and communicating to staff on regular basis.
Monitors pre-certifications to ensure that 100% of all required pre-certifications are obtained.
Responsible to be on call as necessary for departmental emergencies and assistance.
Attends departmental, interdepartmental and campus level Leadership meetings, facilitating as requested.
Possesses understanding of the entire revenue cycle and access services potential for positive or negative impact on hospital accounts, receivables, and bad debt.
Promotes an atmosphere of open communication for staff, clinical partners, and customers (patients, guests, families, staff, physicians, vendors, payors, etc.) at all times, interacting in a professional manner in up-front collection procedures, service recovery initiatives, Payor Joint Operating Committees (in Pre-Access) and general patient or department complaints.
Ensures all patient accounts are created, verified, authorized and/or preregistered in timely manner with appropriate follow up for account completion and up-front collection in all registration or preregistration areas. Ensures 100% compliance with patient preregistration and/or patient discharge process.
Pre-Ensures accuracy and completeness of insurance verification and pre-certification activities.
Adheres to AdventHealth Corporate Compliance Plan and all rules and regulations of applicable local and state and federal agencies and accrediting bodies.
Keeps abreast of regulations affecting reimbursement. Modifies processes to meet reimbursement requirements.
Knowledge of medical terminology, pre-admission, authorization, verification, insurance, medical necessity, reimbursement contracts and departmental and system policies and procedures.
Assists in the annual review and updating of all policies and procedures pertinent to areas of responsibility.
OPERATING & CAPITAL BUDGET/FINANCIAL RESPONSIBILITY:
Prepares documentation and projections to support the operating and capital budget planning process.
Meets monthly budget goals by managing staff levels that are within set labor standards and limiting use of overtime and providing continual coverage - weekend coverage for Pre-Access in order to offer prompt patient service and be available for all clinical partners (pre)registration needs. Regularly reviews monthly budget and volume reports. Limits use of overtime by monitoring productivity. Ensures employee performance and attendance documentation is current and accurate.
STRATEGIC PLANNING RESPONSIBILITY:
Plans, develops, organizes, directs and manages all inpatient, outpatient, emergency (Patient Access only), rehabilitation and preregistration areas (Pre-Access Department only), as assigned. Responsible for all Patient Access outcomes in assigned areas.
Assures timely and accurate flow of information from patent registration to all ancillary departments, nursing units and billing department.
Tracks and offers resolution of issues experienced by physician offices, schedulers, and internal users.
Develop and implement programs that continuously improve quality, strive for excellence and comply with the quality assurance and risk management standards.
Meets with VP to review key indicators addressing any areas of concern and plans for resolution.
Develops and maintains internal controls to assure efficient and effective scheduling of outpatient diagnostic procedures or tests performed throughout the hospital.
PERFORMANCE IMPROVEMENT RESPONSIBILITY:
Actively participates with other departments in campus process improvement initiatives
Meets weekly with VP to review department key performance indicators and improvement initiatives.
Identifies opportunities for performance improvement within areas of responsibility and beyond.
Reports to VP to ensure campus and departmental goals are in direct alignment with organizational initiatives and objectives.
Responsible for department meeting or exceeding productivity, accuracy, and timing goals as designated by hospital senior leadership.
Focuses on process improvement strategies with special focus on up-front cash collections outcomes to protect financial standing of AdventHealth.
Continuously evaluates department processes to maintain efficiency and effectiveness always being open to and searching for opportunities to provide excellent service.
Reviews Pre-Access scorecard indicators and collaborates with campus Directors, addressing any areas of concern and provide any needed resolution.
Responds with agility to change and opportunity. Actively seek new and improved ways to increase productivity.
Maintains a strong pre-admission program to maximize available processing time between patient scheduling and patient arrival for testing/surgery. Minimizes direct patient contact upon pre-scheduled patients arrival to the hospital. Ensures 90% of scheduled patients are pre-registered, including insurance verification of benefits and patient notification of co-payment due at time of admission.
COMMUNITY RELATIONS RESPONSIBILITY:
Advocates team involvement of the Hospital approved community programs, including Backpack for Kids, Adopt a Family, American Heart Association's Heart Walk, and United Way.
Adheres to department operation procedures for response to external disaster protocols, which may include disaster childcare relief.
Responsible for ensuring optimal employee engagement scores that meet or exceed hospital goals.
Responsible for providing staff with resources and training to aid them in meeting or exceeding all performance goals, with a focus on accuracy and timeliness.
Accountable for patient satisfaction and employee engagement scores, meeting goals set by AdventHealth and Revenue Cycle Operations department.
Sets clear, compelling goals for staff and holds team members accountable for performance. Sets the climate for open, frequent communication.
Plans, coordinates and facilitates meetings with staff.
Consistently ensures team members understand the importance of clear and thorough financial and insurance assessments, as well as accurate demographic information to maintain a close working relationship with clinical and financial partners and provide patients with excellent service.
Assesses the work performance and productivity of all assigned team members. Presents written and verbal directions to employees to ensure well-informed status in performance of their job requirements as indicated. Evaluates and disciplines employees according to guidelines established by Department AVP, VP and Human Resources Department of AdventHealth. Makes self-available to provide team members with tools and training needed to assist in meeting accuracy standard goals, minimize department pre-registration errors, rejections, and avoidable denials.
Ensures timely completion of performance excellence evaluations and consistency in application of departmental policies, including those specifically dealing with progressive discipline.
Provides ongoing education to direct reports and ancillary staff performing or assisting with Pre-Access functions to minimize errors in the front-end financial clearance process, to ultimately avoid denials and rejections.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Director, Pre Access opportunity with AdventHealth Maitland and apply online today.
Director, Pre Access, Operations, Maitland
Internal Number: 284598
About AdventHealth Greater Orlando
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.