Regional Director, Patient Access

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

Regional Patient Access Director is accountable for the operational performance of Patient Access across all assigned facilities. This includes daily department operations at every registration point, registration accuracy and data integrity, insurance verification and authorization clearance prior to service, point-of-service collections, work queue ownership and aging discipline, front-end denial prevention, regulatory compliance, and staff competency. The Regional Patient Access Director drives adoption of enterprise Patient Access standards at each site, sustains performance against defined KPIs, and partners with facility leadership, the medical group, and Revenue Cycle to resolve access barriers and eliminate registration-driven revenue loss. The Regional Director also owns Patient Access readiness, cutover, and post-live stabilization for EHR implementations, conversions, and optimization initiative occurring at assigned facilities

Key Duties:

• Working knowledge of Medicare and Medicaid coverage and eligibility rules as they apply at the front end — MSP questionnaire completion, dual-eligible identification, secondary/COB sequencing, TAR and prior authorization requirements, and documentation required prior to service
• Demonstrates the ability to analyze front-end denial data and eliminate root cause at the point of registration — including no-authorization (CO-197), coverage terminated/not eligible (CO-22, CO-109, CO-119), and medical necessity (CO-50, 272) categories
• Possesses the analytical ability to produce and validate accurate patient estimates using deductible, coinsurance, copay, and out-of-pocket maximum -and to estimate output for accuracy prior to point-of-service collection.
• Working knowledge of CPT/HCPCS and diagnosis coding as they relate to order accuracy, medical necessity screening against NCD/LCD policy, and ABN (CMS-R-131) issuance at the time oPossesses strong communication skills to conduct patient financial conversations, request payment at the point of service, present financial assistance options, and de-escalate patient and family concerns at the point of access
• Working knowledge of the registration data elements that drive a clean claim — demographics, guarantor, coverage and COB order, subscriber/relationship, admit type and source, occurrence and value codes — and how registration defects generate rejections and denials downstream
• Ensures compliance with the regulatory requirements governing Patient Access — EMTALA, MSP, HIPAA, Important Message from Medicare, MOON, ABN, Hospital Price Transparency, No Surprises Act, consent and identity requirements, and applicable state registration law.
• Familiar with commercial, Medicare Advantage, managed Medicaid, and exchange plan requirements — including referral and prior authorization rules, PCP assignment, notification timeframes, and network restrictions affecting access to service.
• Maintains current knowledge of payer eligibility and authorization rule changes, CMS regulatory updates affecting Patient Access forms and notices, and state Medicaid program changes — and cascades those changes to staff through updated standard work and education

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. Bachelor’s in Healthcare Administration, Business or related area or equivalent experience

2. Minimum two (2) years of multi-site or regional oversight experience.

3. Demonstrated results in point-of-service collections, registration accuracy, and front-end denial reduction.

4. Ability to travel within the assigned region as required, including on-site presence during system implementations and stabilization periods.

5. CHAA, CHAM, or comparable certification preferred.

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $93,080 to $134,804 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Shift

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf