Director Access & Reimbursement - full-time, exempt

Job Title: Director Access & Reimbursement                                                                 
Job Location: Lincoln
Immediate Supervisor: Vice President and CFO                                                                                         


JOB OVERVIEW

Responsible for oversight and supervision of the Access and Reimbursement Department. Leads the development of the Customer Access System.  Collaborates with the Vice President â?? Referral Relations to advance regional expansion and growth strategies. As liaison between Case Management (CM), Patient Financial Services (PFS) and Admissions provides feedback on complex patient situations that create potential barriers to discharge. Assists with identifying trends and high risk situations for potential barriers impacting future admissions and leads collaboration with CM on barrier resolution strategies.  Represents the Hospital to the public.  Upholds the mission and values of the Hospital.  Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility.


ESSENTIAL FUNCTIONS

• Assists CFO in development of the Customer Access System and ensures efficient billing for services and customer satisfaction.
• Attends weekly PFS/CM Meetings for both campuses.
• Troubleshoot referral admissions issues when payor related.
• Troubleshoot case management issues when payor related.
• Troubleshoot claims issues when payor related.
• Performs quarterly Chart/Billing Audit
• Assists PFS with completion of Social Security and Medicaid application as needed.
• Follow Madonnaâ??s Private Pay Process for any referral that has no designated payor identified at the time of the referral.
• Responsible for management, development and supervision of Inpatient Access Manager and Family Housing Coordinator and oversight of personnel in the Access and Reimbursement department.
• Meet with all Customer Access system personnel routinely to maintain open communication, foster empowerment and improvement strategies.
• Function as the â??Inpatient Case Manager/Financial Analystâ? (job code 850005) in the absence of the â??Inpatient Case Manager/Financial Analyst.â?
• Responsible for management, development and supervision of personnel in the Access and Reimbursement department and inpatient admissions assistants.
• Responsible for development of appropriate back-up in the Access and Reimbursement department.
• Coordinate development of new programs with all involved departments to ensure good external communication, organization and support.
• Promote and support the organizationâ??s mission, values and guiding principle statements within the facility and to the public.
• Must perceive customer relations as a primary focus, and continually strive to satisfy the needs of every customer in all areas of the work force.
• Works closely with the Vice President Referral Relations to advance regional expansion and growth strategies.
  
  QUALIFICATIONS
• Bachelorâ??s Degree in Business, Economics, Nursing, Allied Health or related area required.  Applicable work experience will be considered in lieu of formal education.
• Five yearsâ?? professional experience required, preferably in health care.
• Two years supervisory/management experience required OR demonstrated leadership within a role at Madonna.
• Health care, managed care or payor operations background desirable.  In-depth knowledge required of insurance types (e.g., HMO, PPO, POS, leased networks), insurance terminology, insurance professionals (e.g., case managers, utilization review coordinators, medical reviewers, claims adjudicators, provider liaisons), and insurance payment provisions (e.g., per diems, discount off charges, case rates, carve outs).
• Requires working knowledge of Medicare, Medicaid and Workerâ??s Compensation provisions and how these programs coordinate with commercial insurance coverage.
• Must have valid Nebraska driverâ??s license and proof of safe driving record.