Primary Function

This role oversees the Resource Department at CIHA which includes Medicare, Medicaid, and Private Insurance coordination. The department is responsible for ensuring all patients are screened for resources and assists in obtaining applicable coverage. The incumbent assumes the overall responsibility for the efficient and effective daily management of Resource Department. They will coordinate with the Resource Corporation of America, Local DHHS eligibility workers, CIHA Medicare Part D Coordinator, Public Health and Human Services (PHHS). They are responsible for: ensuring the customer has a world-class experience, ensuring the accuracy of screenings, managing and administering personnel policies and procedures, providing ongoing analysis of departmental effectiveness. This position also serves as a liaison with: Patient Access, Member Services, Billing Office, Health Information Management, Integrated Care Teams, ED, ICC, FCC, and Purchased and Referred Care. Duties performed are in support of the Finance Division and Resource Department in accordance with sound principles, CIHA policies and procedures, and CIHA mission, vision, and values.

Job Description

Create and manage all CIHA resource screening policies
Ensure compliance with CIHA resource screening policies.
Implement and manage workflows with various departments, contractors and Medicaid Eligibility workers to ensure all patients are screened for resources.
Manages the day-to-day operation of the Resource Department including recruiting, selection, training, and supervising of Patient Resource staff.
Perform selections, promotions, awards and corrective action.
Ensure proper staffing in order to appropriately screen all CIHA patients for resources and various departmental requirements.
Plan and facilitate training and development of staff to improve performance and implement industry changes.
Monitor performance of Medicare Coordinator, RCA Screeners, Medicaid Eligibility Workers, and ACA Coordinators.
Monitor and educate Resource Department staff on their responsibility for proper screening of patients.
Ensure they understand they are responsible for the correctness of verifying demographic information.
Train Patient Resource staff on proper sequencing in insurance and resolving questions concerning insurance and pre-certifications.
Investigate and resolve customer concerns, patient or employee incidents in a timely manner.
Communicate operational policies and organizational goals, mission, vision, values by utilizing regular staff meetings, as well as posting policies in a timely manner.
Review new charts, for appropriate screenings for patient resources.
Manage referrals from the Patient Access Department to determine if patient is eligible for alternate resources.
Identify, track, and report weekly bench mark indicators for Patient Resource Department Quality Assurance.
Audit staff workloads on a rolling basis to ensure accuracy.
Streamline process as necessary to ensure patients move through screening without creating obstacles that lengthening time to see provider.
Maintains additional files, records, reports and logs as required.
Performs all job duties according to established safety guidelines and CIHA policies.
Performs other duties requested by director.

Job Knowledge

Demonstrated ability to supervise employees.
Ability to manage a program or department.
Ability to coordinate with various entities to ensure screenings and applications are completed accurately in a timely manner.
Knowledge and skill of teaching and implementing exceptional customer services standards.
Must have leadership, analytical, oral presentation, and decision-making skills.
Outside the organization. Ability to communicate to and interact with persons (staff, health care professionals, individuals in the community) with different functions, levels of knowledge, and requirements.
Ability to maintain quality safety and infection control standards.
Knowledge and ability to independently plan, manage, and organize work in order to meet priorities, accomplish work within established time frames and work in stressful situations.
Ability to solve problems related to data collection, planning, implementing, evaluating, and modifying methods and techniques.
Knowledge of the occupational functions of multi-disciplinary health care teams.
Knowledge of the culture and medical health profile of the patient population.
Knowledge of available health care programs and community resources.
Knowledge and skills in operating a computer, a PBX system and ability to use word processing, spreadsheet, and database programs.
Knowledge of electronic medical record methods.
Knowledge of JCAHO accreditation standards, personnel regulations and safety standards.
Ability to gather and analyze data and communicate findings.
Applicant must have a valid State driver’s license.
Must be able to develop and maintain effective working relationships with fellow managers and area administrators.
Must be able to communicate; verbally and in writing.
Ability to work independently or as a team member is required.

Experience and Job Training

Specific work experience of four (4) years would provide sufficient work background to qualify for the job. Supervisory experience is required. Knowledge of the Medicaid, Medicare, and Affordable Care Act Programs as well as private insurance is required. Experience in a hospital or health related field is preferred. Six to twelve months would be required to learn most phases of the job.

Schooling or Equivalent

A Bachelor’s Degree in Business, Health Information Management or a related field with 2 years of health administration experience is required.

Contact with Others

Has frequent contact with CFO, Director of Accessibility, Resources and Member Services, Resource Manager, Accounting Manager, Revenue Cycle Manager, Medical Records Manager, and Purchased and Referred Care Manager, coworkers and CIHA leaders, and with occasional contacts with auditors. Nature of contacts requires tact, courtesy and professional etiquette to maintain positive working relationships.

Confidential Data

Has access to CIHA’s Patient information, employee wages and other related financial information associated with Patient Registration, which should remain confidential; must adhere to all CIHA confidentiality policies and procedures.

Responsibility for Accuracy

Must perform complex mathematical computations, which are usually verified through RPMS. Undetected errors could require time for research; results could range from minimal to extensive in scope. Work is generally reviewed by others for accuracy and compliance with regulations and procedures.

Mental/Visual/Physical

Close concentration and attention to detail are required while performing all Patient Registration procedures. Is subject to frequent interruptions requiring varied responses. Must have physical mobility, reaching with arms and hands, manual dexterity and visual acuity. Must be able to speak and hear effectively. May occasionally lift more than 15 pounds.

Resourcefulness and Initiative

Works within well defined procedures and guidelines. Uses judgment and initiative to maintain accuracy, respond appropriately to questions and establish work priorities.

Environment

Works in a normal business office in performance of job duties.

Customer Service

Consistently demonstrates superior customer service skills to patients/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all patients/customers by seeking out opportunities to be of service.