Job Description

Job holder is responsible for oversight of all patient facing financial processes. Ensures adherence to policy and procedures for collecting information and counselling Self-Pay, Motor Vehicle Accident (MVA), THIQA Program, ABM, Sponsor International and non-insured patients at time of service. The job holder is also responsible for insurance verification and precertification services for patients presenting for healthcare services within the hospital.

Responsibilities

• Develops continuum of revenue cycle best practices and processes from patient access to collections and revenue recognition.
• Develops and implements new policies, methods and procedures to effectively manage and reduce the patient accounts receivable, maximize collections and reduce bad debt
• Evaluates and implements add on information systems to improve operations and ensure better integration between departments and processes
• Attends meetings and seminars called by the management regarding patient financial services
• Contact physicians, Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer
• Coordinates and works with inpatient accounts for authorization and held responsible for timely notification to payers of the patient’s admission to the facility to protect financial standing
• Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
• Made available proper data source for authorization process ,TAT and financial counselling daily activities including ABM enrolments.
• Maintains closing all pending authorization, GOP, ABM issue to comply with the claims submission timelines.
• Communicates effectively the customer service philosophy of the facility to the current and prospective employees
• Maintains collaborative and effective relationships with other key management personnel and keeps abreast of significant economic, social and technical trends, and regulatory guidelines, which may influence assigned functions/services and/or the facility
• Maintains strong levels of motivation and leadership in the department; effectively communicating and demonstrating a high level of urgency
• Manages workload of the team to ensure proper utilization, performance management, day to day supervision, training and orientation of the staff
• Ensures effective use of progressive discipline when required with corporate Human Resource collaboration
• Prepares and trains the front desk users, routinely undertaking a training needs analysis and facilitating training on documentation, customer services
• Creates and maintains a plan that addresses the initial and continuing development of team
• Supervises the efficient implementation and use of technology by the team to assist in the smooth and efficient flow of information

Accountabilities

• Collects and maintains estimated liabilities from patients.
• Establishes and takes charge of health insurance benefits, conditions, and requirements by making phone inquiries, and by using eligibility systems and the internet.
• Maintains patients’ employment details and other particulars

Qualifications

Required:

• Bachelor’s degree or equivalent in Accounting/Finance/Commerce/Business Administration or relevant field OR Diploma in relevant field with 3 years of additional experience 

Desired:

• Master’s degree or equivalent in Accounting/Finance/Commerce/Business Administration or relevant field

Specialist Certifications:

Required:

• N.A.

Desired:

• Recognized accountancy qualification such as CMA,CPA,ACCA,ACA,CA,CFA or equivalent

Experience:

Required:

• 6-8 years of relevant progressive experience in a similar role with 3 years of supervisory experience Minimum 4 years of medical insurance verification and authorization required;
• 4 years of prior authorization experience in large healthcare, multi integrated network, or third- party medical billing environment
• Experience with insurance terminology is required.
• Experience with managing financial counseling, point of service collections and external vendor relationships related to self-pay receivables is highly preferred;
• Experience with third-party payer requirements, contracts, authorization and payment practices 

Desired:

• Experience in a large healthcare facility