Supervisor, Insurance Program
Oversees and supervises all aspects of the Insurance Program Specialist objections and is responsible for the daily oversight and reconciliation of all self-pay patients. Responsible for ensuring payment solutions are secured for uninsured / underinsured patients to enable them to meet their financial obligations. Works with the director to establish goals, priorities and performance standards and monitors and measures operational metrics, including screening and insurance solutions for uninsured patients, quality, productivity, customer service and collections. The Supervisor is responsible for the coordination and implementation of all day-to-day operational departmental processes. Ensures the integrity of all data collected at time of service to ensure accurate patient identification / benefits information and personally collects and/or facilitates the accurate and timely payment for services provided by leveraging available private / public insurance solutions. Delivers superior internal and external customer service. Works in conjunction with the director and creates an effective team, which emphasizes quality management and efficient, cost effective operations.
• Oversees the processing of payroll for staff, including approving all requests for time off with the director of patient access
• Ensures staff awareness of and adherence to hospital-wide and departmental policies.
• Assures time and Kronos records are completed accurately and maintained.
• Effectively performs personnel tasks including assisting in the hiring, process training, and providing input for performance evaluations. Ensures appropriate staffing based on work load and staff competency.
• Effectively mentors staff and subordinates to maximize their abilities.
• Assists the staff to understand and support organizational policies and objectives
• Coaches and provides guidance to staff and when warranted issues corrective action to staff with direct input from director.
• Conducts and documents regular departmental staff meetings with all department personnel to ensure proper communication
• Assures appropriate performance and documentation of new employee orientation, age-specific competencies in-service education programs and outside educational programs.
• Manages training of all new staff on required competencies, including providing education and preparing new staff for the Massachusetts and Rhode Island state required Certified Application Counselor exams
• Ensures all training manuals and training curricula are up to date and readily accessible
• Creates schedule for staff and covers unexpected absences and scheduled time off to ensure staffing compliment meets demands of department.
• Orients and trains staff on all hospital operating systems including: Meditech; Revenue Protect; MA Health Connector via Optum; Virtual Gateway; Health Source of RI; various payer eligibility tools.
• Responsible for the ordering of supplies from bulk stores and online Steward approved vendors and ensuring the department always has an adequate supply of items needed
• Coordinates the transfer of confidential documents including PHI (Personal Health Information) to Steward approved vendor to storage for required seven years
• Must attend all internal and external meetings related to state and federal insurance programs and educate staff on all policy and program related changes that occur
• Responsible for the daily oversight and reconciliation of all self pay patients, ensuring all have been seen and counseled on their eligibility for and availability of health insurance plans
• Works closely with and effectively communicates to internal and external customers (e.g., patient access, case management, social work, physician offices, insurance carriers, state Medicaid offices) to ensure alignment and customer satisfaction
• Works closely with staff and director to facilitate a team environment where collaboration is fostered
• Ensures all self pay patients have been screened for eligibility of state and federal offered insurance, identifies solution(s) and facilitates patient payment and/or solution application process (manual and/or electronic)
• Collects and verifies patient demographic, insurance eligibility, and financial information/responsibility and accurately documents in hospital computer system(s)
• Follows up and obtains all documentation required for application processing and accurately enters information into hospital and external systems as appropriate
• Identifies via workflow technology current and prior patient responsible balances, educates patients on their financial responsibilities, and collects same
• Assists patients in establishing secured installments plans when applicable
• Interviews patients bedside as needed to facilitate timely and effective payments and/or complete insurance solution application process
• Monitors, manages and actively follows up on active self pay accounts to ensure solutions / solution modifications in place for patients and optimize ultimate payment for the hospital.
• Establishes schedule for "walk-in" insurance assistance applicants and facilitates application process for same
• Fields patient billing inquiries and refers to appropriate PFS staff for resolution
• Meets performance standards established by Patient Access leadership, including but not limited to: quality, collections, customer service, screening/solution rates and productivity
• Keeps current with all internal and external policy and procedures that may affect reimbursement
• Delivers exemplary customer service for patients in accordance with hospital expectations / guidelines
• Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional , responsible and courteous environment
• Commits to recognize cultural diversity and communicate effectively with internal and external customers with respect of differences in culture, values, beliefs and ages
• Performs all other duties as assigned.
REQUIRED KNOWLEDGE & SKILLS:
• Maintains detailed knowledge of private, public and third-party payer insurance and related regulations
• Proficient with Massachusetts Medicaid eligibility requirements, and a detailed knowledge of navigation of insurance application process
• Detailed knowledge of medical terminology
• Outstanding communication and interpersonal in a customer service-based health care setting
• Ability to work with a high degree of confidentiality.
• Familiarity with Meditech preferred
• Detailed knowledge of Microsoft Office tools
• Comprehensive knowledge of tools, systems, and technologies to enable insurance verification and facilitate insurance solutions
• Experience with securing solutions for uninsured patients
• Detailed knowledge of health insurance and reimbursement/billing required
• Ability to problem solve and follow through under ambiguous circumstances
• Ability to show empathy and encouragement to patients and their family members
• Bilingual in Portuguese preferred
• Associate's degree preferred. High School Diploma or equivalent required.
• 6-8 years in hospital or community health center registration/billing office/clinic and with a current detailed knowledge of Massachusetts Medicaid eligibility and insurance program options.
• Must have Certified Application Counselor (CAC) certification in Massachusetts and Rhode Island.
• Recertification is required yearly