Manager, Patient Financial Services

Description

POSITION SUMMARY
The Manager of Patient Financial Services (“Manager”) oversees activities designed to increase awareness of and access to health coverage and related services for uninsured and underinsured patients. The Manager ensures that patients are consistently afforded the opportunity to enroll in appropriate coverage, including Affordable Care Act (ACA) plans, Medicaid, Medicare, and other applicable programs, and plays an integral role in the oversight of Coordination of Benefits (COB), as well as the administration of the Sliding Fee Discount Program (SFDP) and the Fee Waiver Program.

The Manager serves as a resource to support discussions with patients regarding available insurance options, as appropriate, and facilitates referrals to the Community Health Worker team to promote consistent and accurate outreach, enrollment, and access to financial assistance opportunities in accordance with organizational policies and regulatory requirements across all service locations. The Manager also provides reporting oversight of billable CCM/CHI services performed by Community Health Worker team members to ensure that services are properly documented, coded, and billed.

This is a key leadership position whose primary objective is to ensure the effective organization, planning, and implementation of activities that have a direct fiscal impact on the organization’s ability to deliver comprehensive, high-quality care to patients.

REPORTING RELATIONSHIPS

This position reports directly to the VP of Revenue Cycle and serves as a resource to the Manager of Patient-Centered Services by providing guidance and support for the Community Health Worker (CHW) team’s education related to health insurance enrollment. The Manager of Patient-Centered Services retains responsibility for the CHW team’s overall supervision, performance, and outcomes associated with patient outreach, engagement, and health insurance enrollment activities. 

ESSENTIAL JOB DUTIES AND FUNCTIONS

While living and demonstrating our Core Values, the Manager of Patient Financial Services will:

• Oversee the administration, continuous process improvement, and point-of-care implementation of the Sliding Fee Discount Program (SFDP) for uninsured and underinsured/self-pay patients across all clinical and service delivery sites.
• Coordinate the SFDP application and verification workflows, including specialized intake protocols for patients experiencing homelessness, and monitor key operational metrics (e.g., applications completed at time of visit vs. post-visit follow-up).
• Oversee policies regarding services not covered under the standard sliding fee schedule (e.g., specific medications, vaccines, and specialized procedures), providing timely guidance and support to clinical and front-desk teams.
• Prepare and present quarterly SFDP outcome reports, trend analyses, and quality/compliance assessments to executive leadership and the Board of Directors.
• In collaboration with the VP, Revenue Cycle, oversee and administer the Fee Waiver process for patients demonstrating exceptional, documented financial hardship.
• Establish clear, compliant criteria, review mechanisms, and workflows to ensure fair, equitable, and consistent adjudication of fee waiver requests across all service locations.
• Track fee waiver volumes, financial impact, and utilization trends, reporting findings quarterly to the Executive Management Team and the Board of Directors.
• Provide guidance and support to the Community Health Worker (CHW) team in resolving patient Coordination of Benefits (COB) issues, including unpaid claims and insurance payment retractions. Collaborate and ensure timely follow up with the Manager of Patient-Centered Service to address coverage and billing issues, while facilitating appropriate reimbursement for services rendered, and ensure timely follow-up.
• Support the Community Health Worker team in patient outreach and enrollment activities in health insurance programs and monitor results, including positive performance trends. 
• Assist with organizational education initiatives regarding insurance affordability and enrollment through the Federal or State-Based Marketplace (PENNIE) and other health coverage programs, including Medicaid, Medicare, Children’s Health Insurance program (CHIP), and related programs. 
• Provide guidance and counsel regarding the Affordable Care Act (ACA) and the Health Benefit Exchange, serve as a resource for the organization, and maintain current knowledge in eligibility, enrollment, and program specifications for Federal or State-Based Marketplace insurance programs and other health coverage programs such as Medicare, Medicaid, and CHIP.
• Serve as a resource to the Manager of Patient-Centered Services, as needed, to ensure the Community Health Worker team provides appropriate documentation in CCM/CHI minutes related to insurance outreach with patients, including Coordination of Benefits (COB) issues and time spent.
• Oversee and help review the monthly CHI services performed and billed each month.  Help integrate the clinical aspects of what is being documented in the patient chart to the billing outcomes each month.  Assist the Revenue Cycle team with training related to these issues in order to bill a proper foundation for the billing.
• Serves as a resource for Front Desk, Community Health Workers, and Revenue Cycle team members on outreach and enrollment services, Sliding Fee Discount Program (SFDP), Fee Waiver Program, Coordination of Benefits (COB), and Insurance Coverage. 
• Lead and coordinate workflows across Front Desk, Community Health Workers, and Revenue Cycle team members to ensure consistent, compliant processes for above processes to promote effective collaboration among teams.
• Analyze data to identify trends, gaps, and opportunities for operational, quality, and process improvements. Implement continuous improvement initiatives as appropriate.
• Provide oversight and design of strategies and overall implementation work flow to ensure access to health coverage and care. Establish and document workflows in order to ensure gaps in service delivery areas are met. This can include leveraging Plan Do Study Act (PDSA) tools to enable process improvement protocols.
• Provide referrals for patients with health insurance questions, complaints or grievances to the appropriate consumer assistance program, health insurance ombudsman, or other applicable state or federal agency in coordination with the VP, Revenue Cycle.
• Participate in regularly scheduled calls, meetings, and trainings in order to provide accurate, quality services. This includes participation in the Centers for Medicare and Medicaid Services (CMS) trainings and other required training to enhance outreach and enrollment expertise.
• Other duties as assigned.

Requirements

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
• Buy in and experience working in the EOS® model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
• Associates degree or equivalent experience
• Leadership skills in supervision and management of staff, including implementing performance metrics, workplans, and project management.
• Experience in taking initiative, critical problem-solving, ensuring data-driven decision-making protocols, delegating and assigning work to appropriate staff.
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride.
• Possess the ability to work within a culturally, socioeconomically and educationally diverse population.
• Must be able to work independently as well as collaborate and communicate effectively with colleagues, supervisors, and health care providers to build and maintain effective dynamic professional team relationships.
• Must thrive in a team environment, possess excellent organizational skills, and be able to effectively handle difficult interpersonal situations.
• Experience with MS Office Suite and Google platform.