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Payers Direct Jobs in Virginia (NOW HIRING)

Revive Bhs Llc

Executive Director

Henrico, VA · On-site

$80K - $120K/yr

The Executive Director oversees program performance, fiscal sustainability, quality improvement ... Community Payer Relations ● Maintain relationships with Virginia Medicaid MCO representatives ...

Direct Jobs

General Child Neurologist (MD/DO)

Fairfax, VA · On-site

$200 - $300/hr

Payer Credentialing: Ability to successfully complete the credentialing process by third-party payors and enroll as a CMS Medicare/Medicaid payer. * Medical Staff Credentialing: Successful completion ...

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What is the difference between Payers Direct vs Payers Account Manager?

AspectPayers DirectPayers Account Manager
CredentialsTypically requires insurance or healthcare-related certifications, such as CPC or CPC-HOften requires similar certifications, with additional experience in client management
Work EnvironmentPrimarily office-based, handling claims processing and payer communicationsOffice setting with client interaction, focusing on account management and relationship building
Employer & IndustryHealth insurance companies, healthcare providers

While both roles involve working with payers in the healthcare industry, Payers Direct focuses on claims processing and payer communication, whereas Payers Account Managers emphasize maintaining client relationships and account oversight. Understanding these differences helps in choosing the right career path or job search focus within healthcare insurance roles.

What are popular job titles related to Payers Direct jobs in Virginia? For Payers Direct jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Payers Direct jobs in Virginia look for? The top searched job categories for Payers Direct jobs in Virginia are:
What cities in Virginia are hiring for Payers Direct jobs? Cities in Virginia with the most Payers Direct job openings:
Payers Direct jobs near you
Director Patient Access Services

Director Patient Access Services

Chesapeake Regional Medical Center

Chesapeake, VA • On-site

Other

Posted 24 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Director of Patient Access Services (PAS) is responsible for planning and directing the activities for all patient access and registration services. This includes, but is not limited to central scheduling, pre-registration, financial counseling, insurance verification/authorization, admission, outpatient registration, upfront and point-of-service cash collection.
This position is responsible for ensuring that key performance indicators for PAS functions (both centralized and decentralized) are consistently developed, measured and achieved.
Essential Duties and Responsibilities
  • Oversee facility operations of Patient Access functions (e.g., pre-registration, benefit verification, pre-authorization, admission/registration, service pre-payment, etc.) to ensure daily operations are maintained according to standard.
  • Provide ongoing operational analysis and support to all access/registration areas to effectively maintain best practice processes, policies and procedures, including but not limited to Pre-Services, Registration, Upfront/PCS Collections and Registration Quality Assurance Management.
  • Implement Patient Access process improvement initiatives as needed to improve workflows for patient access and to achieve departmental, hospital and corporate goals.
  • Maintain enhanced physician practice, patient and staff relations, creating an environment conducive to maximizing internal and external customer satisfaction.
  • Manage personnel responsible for supervision of all staff in assigned Patient Access Areas. Leads the development and implementation of all necessary reporting, monitoring standards and processes associated with assigned revenue cycle areas and establishes benchmarks for best practice operational efficiency.
  • Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education. Inform staff of relevant changes and developments in payer requirements.
  • Ensure quality review measurements are in place.
  • Foster collaborative relationships with other department managers, senior leadership and staff to facilitate the strategic planning and development of Patient Access operations.
  • Develop specific objectives, budgets, and performance standards for each area of responsibility.
  • Assist with identifying capacity issues that create barriers to patient flow.
  • Interface with external entities such as third-party payers, regulatory agencies, other health care institutions, vendors, patients and families.
  • Assure compliance with Advanced Beneficiary Notification (ABN), Medicare as a Secondary Payer Questionnaires (MSPQ), Advanced Directives, Patient Bill of Rights, medical necessity, observation status and other regulatory guidelines.
Summary of Other Job Responsibilities/Expectations
  • Inform CFO of any significant issues in the Patient Access area (e.g., Pre-registration delays, pre-authorization backlogs, etc.)
  • Attends in-service presentations, and complete mandatory education week including, but not limited to, infection control, patient safety, quality improvements, MSDS and OSHA Standards.
  • Demonstrates knowledge of occurrence reporting system and utilizes system to report potential patient safety issues.
Supervisory Responsibilities
  • Reports to: Chief Financial Officer (CFO)
  • Supervises: Patient Access and Registration Staff, collaborates with department managers who also have PAS responsibilities
  • Responsibilities: (i.e., Budget)
Qualifications
  • Demonstrated success in managing day-to-day operations of a large-scale, high-volume patient access functions.
  • In depth knowledge of general business concepts including financial management and accounting principles and practices.
  • Demonstrated track record of meeting department goals without an adverse impact on employee morale or customer satisfaction.
  • Ability to plan, direct, and control the affairs of admitting and registration department.
  • Ability to establish rapport and cooperation between staff in patient financial services, utilization review, HIM, hospital management, IT, payers and all other departments that impact patient access functions.
Education and Experience
  • Minimum Required Education: Bachelor's Degree in related field or must be actively pursuing degree and have equivalent relevant experience.
  • Preferred Education: Masters
  • Experience: Extensive experience with Medicare, Medicaid, managed care and commercial payor requirements. Strong knowledge of compliance requirements for Patient Access-related activities, including, but not limited to federal, state and accrediting regulatory agencies. 10+ Years Healthcare Business, Finance and/or Revenue Cycle experience in acute care hospital or related organization.
  • Minimum 5 years management experience
  • Employee should be competent in position within 90-days of employment

Certificates, Licenses, Registrations
Healthcare Access Management Certification, (CHAM), Healthcare Financial Management Association Certification, (CHFP) or Healthcare Financial Management Association-Certified Revenue Cycle Representative, (CRCR) or other related certification preferred.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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