JOB DESCRIPTION
DATE POSTED: December 20, 2023 **Updated on December 27, 2023***
POSITION TITLE: REGIONAL REGISTRATION & PAYER REIMBURSEMENT MANAGER
JOB STATUS: Exempt | Full-Time WITH Benefits (1.0 FTE)
SALARY: Negotiable
JOB LOCATION: This regional position is located in the Patient Financial Services (PFS) department of Kaua’i Veterans Memorial Hospital (KVMH), Samuel Mahelona Memorial Hospital (SMMH), and The Kaua’i Region Clinics, consisting of The Clinic at Waimea, The Clinic at Port Allen, The Clinic at Kalāheo, The Specialty Clinic at Kalāheo, Urgent Care at Po’ipū, The Clinic at Līhu’e, and the Clinic at Kapa’a, all of which are part of the Hawai’i Health Systems Corporation (HHSC) Kaua’i Region, a public benefit corporation of the State of Hawai’i.
The Patient Registration and Reimbursement Services is a function within the PFS department that gathers and processes demographic and financial information to complete patient registration; collects data and inputs information into the hospital’s computer system; provides cashier services, PBX, and financial counseling; works with our corporate reimbursement department to negotiate payer contracts that will benefit our CAH reimbursement structure and identify payment trends to ensure proper reimbursement in accordance with executed contracts.
JOB FUNCTIONS: The Regional Registration and Payer Reimbursement Manager oversees the activities of a non-clinical team within Kaua’i Region consisting of Case Management and Utilization Review and directly manages Patient Access, Financial Counseling, and PBX; manages and develops specific activities to help support patients using various assistance and discount programs as we as developing the infrastructure required to implement centralized scheduling, pre-registration, and pre-authorization teams. This position represents HHSC Kaua’i Region as lead contract negotiator and subject matter expert during contract negotiations by displaying proficiency and distinction related to CAH reimbursement. Incumbent must understand and interpret Medicare, Medicaid, HMSA, and other third party payer contract terms and reimbursement methodology to ensure reimbursement are made in accordance with regulatory guidelines and/or contract terms; responsible for analysis of performance metrics to improve process performance. This position also maintains all levels of the Admission process in conjunction with The Joint Commission standards and HIPPA regulations; develops and maintains working relationships with physicians, nurses, and office staff, as well as other customers within and outside the facility, including any other duties as assigned. This position reports to the Regional Chief Financial Officer, position no. 109672, or its designee.
MINIMUM QUALIFICATION REQUIREMENTS
To qualify, you must meet all of the following requirements. Please note that unless specifically indicated, the required education and experience are credited based on a 40-hour workweek. All applicants are required to provide evidence of all applicable education, licenses, and certifications.
Education: Bachelor’s Degree from an accredited four (4) year college or university. Relevant substitutions allowed.
Licensure: Current, valid type# 3 driver’s license preferred.
Certification: None required.
Specialized Experience: Three (3) years of progressively responsible professional work experience which has demonstrated advanced knowledge of public and private health care programs including admissions and registration, billing, reimbursement, follow up and collection activities of a healthcare institution. This experience must have provided familiarity with, and knowledge of admission procedures; reimbursement procedures; interviewing patients and/or responsible persons to secure information; arranging for method of payment for costs not covered by insurance and general financial practices of healthcare providers.
Supervisory Experience: Two (2) years of current healthcare setting experience which demonstrated the applicant’s knowledge of and ability to apply the principles, practices, techniques and methods of supervision including: (1) planning, organizing and directing the work of others; (2) assigning and reviewing work; (3) advising others on difficult work problems; (4) timing and scheduling work; and (5) training and developing employees.
DESIRED SKILLS & ABILITIES
Knowledge of: principles and practices of supervision and management in the admission process; business office functions which include billing, follow up, collections, and account maintenance; a comprehensive knowledge of pertinent laws, polices, regulations and procedures regarding admissions, reimbursements, billing and collection procedures of third party and private insurance payers; Advanced Beneficiary Notices and Health Information Portability and Accountability Act (HIPAA) laws.
Ability to: plan, organize and direct the work and activities of staff; develop, implement, and modify as necessary, methods and procedures relating to admissions and registration and healthcare billing and collection and credit operations; understand data processing information systems used, develop policies and procedures; and establish and maintain effective working relationships with others; foster an environment that nurtures collaboration, teamwork, and mutual respect; evaluate processes and to recommend improvements as necessary; work with patients, physicians, and department staff; formalize orientation and training of staff on an on-going basis.
WORKING CONDITIONS/HEALTH & PHYSICAL REQUIREMENTS
Applicants must meet the health and physical requirements deemed necessary to effectively and safely perform the essential functions of the position with or without reasonable accommodation.
May be exposed to infections and contagious diseases. Mainly sedentary with occasional standing/walking. Generally lifting not more than 10lbs. and occasionally lifting and/or carrying such articles as ledgers, files, and small items. In addition, applicants must possess emotional and mental stability. High stress climate requiring the ability to conduct several projects simultaneously and maintains stability in department.
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