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Plans and directs business office operations of the medical facility to ensure that revenue management functions meet customer and organizational requirements. Plans and directs business office operations to include such functions as admitting, patient registration, billing, collections, and insurance claims. Typically requires a college degree in business and related managerial experience.: Assists in coordinating and maintaining patient financial services programs to ensure compliance with current payments, rules, and regulations that impact the medical center and/or physician's billing and collections process. Monitors and ensures compliance with Medicare and Medicaid documentation guidelines. Monitors and evaluates current reimbursement/payment rules and ensures that legislative and regulatory changes impacting medical billing are anticipated and communicated to the clinical faculty, staff, and departmental billing personnel. Develops techniques for effective analyses of billing and collections efforts. Oversees resolution of third party denials and assists with reimbursement appeals and problems. Prepares financial reports and analyses to show progress or adverse trends and makes appropriate recommendations or conclusions. Assists in identification of new technologies that will improve departmental operations. Develops departmental strategies to meet cash projection formulas, reduce days in Accounts Receivable, and reduce denials. Ensures compliance with State and Federal law, compliance plans, HIPAA, and JCAHO guidelines. Prepares and manages the departmental budget. Hires, develops, and motivates a qualified Patient Financial Services staff. May provide assistance to physicians in determining appropriate use of codes for maximizing reimbursement of physician services.

Health Advocate

Provides health outreach, education, and support services to targeted populations to improve awareness about designated program(s) and resources. Communicates directly with patients to resolve their medical, pharmaceutical, behavioral health, dental, and Medicare issues. Advocates on behalf of patients in dealings with health insurance administrators, external third party payers, collection agencies, and provider offices.: Registers participants in the advocacy system and opens case files. Screens participants and provider requests for services. Educates participants about services, benefits design, and claim process. Troubleshoots claim issues/denials. Develops and maintains relationships with key physicians and hospital staff. Researches and reports options for healthcare treatment, physicians, and facilities. Schedules healthcare appointments and coordinates administrative functions. Assists patients with travel arrangements and cultural needs. Accompanies patients to appointments when necessary. Obtains and updates member medical records. Maintains member and physician databases. Supports care managers in the handling of crisis calls. Provides follow-up calls to patients to assess level of service satisfaction. Assists Intake Coordinator, provides mentoring, and assists in training when necessary.

Patient Relations Director

Provides leadership, organization, planning, direction, and administration to the operational aspects of the Patient Relations Department and its services. Collaborates with key members of the Hospital, Physician Practice, Service Excellence, Risk Management, and Quality/Safety Departments to investigate and assist in resolving patient complaints. Oversees staff who receive complaints and establishes processes for investigation and response.: Facilitates communication between departments and providers to ensure timely resolution of complaints. Collects data and information about patient care concerns and makes recommendations as appropriate. Resolves conflicts and acts as intermediary between patients, families, and staff. Recommends establishment of policies and operating procedures to ensure positive patient-Hospital relations. Prepares reports and analyses on progress, adverse trends, and appropriate recommendations or conclusions. Develops and tracks annual department budget.

Medical Patient Relations Representative

Serves as liaison between the employer, patients, and patients' relatives in resolving patient care problems. Resolves patients' complaints and grievances. : Conveys questions, complaints, problems, and concerns of patients to proper personnel. Describes and interprets patient care procedures, and policies to patients. Prepares reports regarding incidents that may result in legal action if not settled. Trains staff on humanizing patients' care. Establishes rapport with personnel. Takes part in employer's public affairs activities.

Legislative Advocate

Represents a major client, usually at the national level, and provides strategic policy direction, and lobbies for client's interests on issues of major importance. Contacts and confers with members of legislature and other holders of public office to persuade them to support legislation favorable to client's interest. Studies proposed legislation to determine possible effect on interest of client, who may be a person, specific group, or general public. May direct lower level lobbyists.: Confers with legislators and officials to emphasize supposed weaknesses or merits of specific bills to influence passage, defeat, or amendment of measure, or introduction of legislation more favorable to client's interests. Contacts individuals and groups having similar interests in order to encourage them also to contact legislators and present views. Prepares news releases and informational pamphlets and conducts news conferences in order to state client's views and to inform public of features of proposed legislation considered desirable or undesirable. Plans and coordinates meetings between members and elected officials to discuss legislative issues and proposals and allow officials to respond to membership concerns. May contact regulatory agencies and testify at public hearings to enlist support for client's interests. May be legally required to register with governmental authorities as lobbyist and to submit reports of regulated expenditures incurred during lobbying activities. May attend and represent local organization at state and national association meetings. May instruct individuals or organization members in lobbying techniques.

Patient Care Executive

Provides executive leadership for a broad range of patient care operations to include nursing and several other professional services departments such as rehabilitation, respiratory care, pharmacy, diagnostic imaging, and laboratory services.: This position typically reports to the CEO or COO of the organization. Plans, organizes, implements and evaluates outcomes of the patient care strategic plans. Develops strategic patient care initiatives and transforms initiatives into action plans. Performs regular data analysis of hospital census, quality data and operations cost reports to identify variances and their causes so that areas of focus may be identified and resources may be appropriately deployed. Works closely with the Medical Director to ensure that patient care services are provided in an efficient and effective manner. Provides oversight and direction in establishing and maintaining a system for developing, reviewing, approving and disseminating standards of clinical practice. Assists in reviewing and making recommendations on policy issues regarding clinical practice with appropriate discipline within the organization. Prepares and manages the departmental budget. Hires, develops and motivates a qualified patient care management staff. An advanced degree in a field of health or nursing is typically required for this position. The position typically requires strong clinical and quality improvement knowledge.

Medical Top Patient Care Executive

Directs, through managers, supervisors or head nurses, activities of nursing staff. Administers nursing program in hospital or other medical institution to maintaining standards of patient care. This is the highest level position in patient care.: Plans and organizes activities in nursing services, such as obstetrics, pediatrics, or surgery, or for two or more patient-care units to ensure patient needs are met in accordance with instructions of physician and hospital administrative procedures. Coordinates activities with other patient care units. Advises medical staff, department heads, and hospital administrator in matters related to nursing services. Recommends establishment or revision of policies, and develops organizational structure and standards of performance. Interprets policies and objectives of hospital nursing services to staff and community groups. Performs personnel management functions. Plans and organizes orientation and in-service training for unit staff members, and participates in guidance and educational programs. Assists in formulating budget. Engages in studies and investigations related to improving nursing care. May direct activities of school of nursing.

Patient Care Manager

Coordinates an interdisciplinary plan of care to guide patient progress toward achieving clinical, quality, and cost effective outcomes. Monitors all care rendered to patients and families. Serves as patient advocate.: Establishes, implements, and evaluates goals and objectives for services that meet and promote standards of quality. Provides daily direction to team, including care planning and documentation. Implements team building and staff support activities. Schedules team members to assure appropriate levels of care. Collects, trends, and analyzes aggregate outcomes data to be used in identifying best practices and targeting performance improvement efforts. Ensures compliance with all local, State, and Federal regulations. Manages all patient care expenditures and staffing model to assure compliance with budget. Assures that all outside services are properly authorized and bills are accurate. Hires, trains, orients, supervises, and evaluates qualified interdisciplinary team personnel.

Patient Care Specialist

Performs a variety of technical and direct patient care services for a specialized group of patients to assist medical professional personnel in diagnostic, therapeutic, and research procedures. Assists Physician in performing diagnostic, therapeutic, and research procedures to diagnose medical and surgical problems and assists in prescribing necessary treatment and services for quality patient care.: Confers with patients to obtain information for chart and laboratory records. Orders and schedules lab studies and diagnostic procedures. Explains the necessity, preparation, nature, and anticipated effects of scheduled diagnostic and therapeutic procedures to the patient. Assists Physician with therapeutic procedures. Performs patient workups and summaries noting pertinent positive and negative findings. Records the normal and abnormal data for review by Physician. Monitors progress of patients, reports progress to Physician, and maintains records of patient progress. Attends daily rounds and consults with Physicians, nursing personnel, and other members of the healthcare team to provide diagnostic and prognostic information. Operates equipment to monitor and obtain recordings of specific body functions. Calculates, compiles, and records data obtained from graphs and numerical readings. Participates in research projects conducted by supervising Physician. Compiles, analyzes, documents, and assists in the interpretation and evaluation of results. Calibrates and performs routine maintenance on equipment to ensure proper functioning. Cleans and sterilizes instruments, supplies, and equipment. Maintains inventory of supplies and reorders as required.

Patient Representative

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