MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree in Business Administration, Health Care Administration, or other related fieldANDOne year (1) of experience in a healthcare settingANDOne (1) year of supervisory/management experienceOR;

High School Diploma or EquivalentANDThree (3) years of experience in a healthcare settingANDOne (1) year of supervisory/management experience.

PREFERREDQUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Obtain Certification and proficiency status within Prelude and Physician Clinic Registration revenue cycle readiness

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Plans, implements, manages and evaluates the delivery of operational processes as it relates to patient care in accordance with the policy and procedures, philosophy and mission.

2. Ensures all ambulatory registration and centralized scheduling staff provides quality, effective service that is consistent with relevant policies, procedures and access and service standards.

3. Works closely with staff and peers to identify opportunities to improve patient processes.

4. Facilitates the development of organizational policies and procedures and ensures compliance.

5. Promotes customer satisfaction in a professional, constructive manner.

6. Collaborates with Director, Ambulatory Clinical Access and VP of Ambulatory Operations to ensure program goals are established and achieved.

7. Responsible for the management, organization and delegation of operational aspects within the ambulatory clinical sites to ensure effective, efficient delivery of services.

8. In conjunction with Director, Ambulatory Clinical Access and in accordance with mission and goals, determines the service needs in terms of patient and staff requirements. Assures that staff provides patient focused care. Resolves patient care issues as identified.

9. Reviews outcomes and evaluates operational systems to ensure ongoing improvement.

10. Creates a work environment that promotes continuous quality improvement, team building and ongoing personal development.

11. Collaborates with medical staff and other personnel in promoting and planning optimal patient services. Collaborates regularly with physicians and ancillary service providers to review practices, services and resolve issues

12. Selects, hires, terminates, manages and evaluates the effectiveness of employees on a continuous basis. Promotes teamwork, contributing to positive employee morale. Performs performance evaluations that provide objective, constructive feedback regarding strengths and opportunities for improvement. Coaches and counsels to correct identified performance deficiencies. Establishes goals, and provides follow up within established Human Resources policies. Ensures compliance with policies and ensures staff meets the established access and service standards. Devises communication system to keep all personnel informed of operations.

13. Fosters a competent staff through the provision of orientation, in-services, continuing education programs and professional development.

14. Responsible for developing and monitoring the ambulatory operations, call center, HA&I budget for personnel, materials and services. Assures cost effective staffing patterns, reviews trends and variances to develop long range plans for budget needs with the Director, Ambulatory Clinical Access and VP Ambulatory Operations.

15. Participates in committees and completes additional projects as assigned.

16. Responsible for the oversight and efficiency of practice operations of our registration areas and centralized contact center, referral center within Ambulatory sites of service.

17. Responsible for the oversight of pre-certification, authorization, and verification functions to ensure registration and billing compliance, in conjunction with all organizations' management and faculty physicians

18. Implements processes to respond to changing managed care contracts and requirements.

19. Actively participates in on-going policy and procedure reviews and revisions to Ambulatory Operations systems and processes

20. Keeps abreast of all regulations and standards issued by governmental/regulatory agencies and third party payers; implements organizational changes, as required, ensuring organizational compliance.

21. Represents Ambulatory sites of service and Hospital at scheduled meetings with all related departments and entities, third party payers and customers, as needed. Revises policies and procedures to reflect any required changes.

22. Assures organizational compliance relating to all managed and non-managed care contracts, and government entities to ensure submission of timely, clean claims and strong cash flow through prompt payment.

23. Maintains EPIC certification and proficiency status within Prelude and Revenue Cycle readiness to be able to effectively make decisions in regards to operational process changes.

24. Tracks key performance measures/success factors (quality, financial outcomes, productivity, etc.) to maximize Ambulatory sites of service contribution to WVUH.

25. Act as departmental liaison with internal and external customers as it related to access in the healthcare services of all organizations.

26. Actively participates in the development and attainment of organizational goals and objectives as it related to the organizational strategic mission and initiatives.

27. Point of contact for the organizational physician liaisons with operational issues related to all patient areas within the ambulatory sites of service, including call center, MARS andHealthline.

28. Facilitate organizational and system widepayor/plan meetings and assist in the decision making process to determine what insurances that need to be uploaded into EMR

29. Act as departmental liaison for Ambulatory Administration with the Informational Technology team with EPIC reporting, responsible for the requests and monitoring of these reports as they are processed through our team and IT.

30. Liaison for all Insurance Specialists within all ambulatory sites of service, working directly with WVHS contracting specialists to be sure that we are following correct guidelines for ourpayor/plan contracts

31. Assists with implementing processes to reduce denials for insurances, controllable adjustments regarding imaging testing, surgeries, etc.

32. Facilitates monthly and/or quarterly meetings for Insurance specialists to review concerns, new insurance rules, contracts, etc.

33. Facilitates monthly front desk coordinator meetings to review operational changes, updates for all departments, etc.

34. Assists director with implementing new processes and or procedures for all ambulatory sites of service and call center areas.

35. Responsible for the communication to all coordinators regarding process and/or policy changes.

36. Works directly with accounting to ensure deposit processes are in place for all ambulatory sites of service.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Knowledge of accounts receivables management, billing and collections, and the registration and managed care components that affect revenue cycle operations.

2. Financial, technical and professional skills.

3. Oral and written communication ability to effectively represent the Ambulatory sites of service and Hospital in interactions with third party payers, patients, physicians and other departments.

4. Analytical and problem solving skills as well as the ability to work and communicate effectively with other departments.

5. Working knowledge of local, State and Federal regulations pertaining to Professional billing and collections. In addition, Provider Based Billing that affect Professional and Hospital billing

6. Ability to perform a variety of duties, ranging from direct involvement in various projects to coordination and supervision of the activities of co-workers.

7. Knowledge of spread sheet, word processing and office software applications.

Additional Job Description:

Scheduled Weekly Hours:

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