Stanford Health Care

Financial Planning and Analysis

• Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department and assigned service line.
• Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days.
• Contacts patient as appropriate to obtain correct and updated information when necessary.
• Completes Medicare Secondary Questionnaire as appropriate.
• Applies authorization rules and requirements for all payors within the assigned work queues.
• Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient.
• Assesses the data required for authorization and securing sponsorship.
• Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization.
• Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue.
• Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed.
• Prioritizes work assigned to them to ensure that financial risk is minimized, and timely completion of authorizations is optimized, while meeting daily productivity measure goals.
• Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address.
• Identifies risk associated with securing financial clearance prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR).
• Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely.
• Properly refers these cases as appropriate.
• Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work.
• Applies strong writing skills to account documentation, email communication and internal notes/memos.
• Manages outbound and inbound phone calls.
• Responds promptly to customer inquiries.
• Assists team coordinator and department manager with special projects as needed.
• Serves as a resource for other payor authorization teams.
• Performs other duties and responsibilities as assigned by the Department.

Financial Clearance Representative I – Clinical Lab Genomic Testing

Compliance

• Ensures organizational compliance with federal/state regulations and accreditation requirements for medication management
• Designs, performs, and revises monthly compliance inspections
• Develops and contributes key performance indicator (KPI) data to the Pharmacy Quality Dashboard
• Communicates and educates operational staff on medication-related issues

Pharmacy Quality Compliance Coordinator

• Responsible for planning, organizing, leading and directing the overall patient financial clearance functions
• Ensures financial clearance functions are performed efficiently throughout the Patient Access services enterprise
• Maintains a complete record of current policies and procedures followed by staff
• Develops goals and priorities, and assigns tasks and projects
• Provides effective leadership and manages appropriate staff levels
• Collaborates with other departments to ensure processes and systems for patient financial clearance are standardized and optimized

Manager – Patient Financial Clearance

Project Manager

• Provides project management for project activities to ensure that the project is completed in scope, on schedule, within budget.
• Responsible for the coordination and completion of concurrent projects of various sizes.
• Oversees all aspects of projects.
• Tracks milestones and anticipates deadlines, assign responsibilities, and monitor and summarize progress of project.
• Monitors project progress using internal tools, providing clear and concise status reports to management and stakeholders.
• Proactively identifies potential issues, collaborates with leaders on mitigation strategies, and tracks project milestones for successful delivery.

Project Manager – Pharmacy

Engineer

• Plans, organizes, manages and is responsible for all document control and distribution processes
• Meets regularly with all the parties involved to stay abreast of and track the status of construction projects
• Prepares meeting agendas as needed and records and distributes minutes summarizing matters discussed
• Scan, distribute, and file documents including project designs, drawings, specifications, estimates, and correspondence

Project Engineer

• Oversee daily operations for patient financial clearance functions
• Ensure compliance with policies related to pre-registration, payer authorization
• Lead and coordinate initiatives with hospital clinic leadership
• Develop strategies for operational improvement

Senior Manager – Patient Financial Clearance

Translator

• Provide ASL interpretation services to all Stanford Health Care departments for patient care
• Participate as a neutral party in the role as conduit of information between staff and patients/visitors
• Ensure accurate communication of patient's outpatient services and hospitalization information
• Translate correspondence, medical histories, and other pertinent documents as needed
• Maintain accurate daily records on all requests for service as well as the provision of services

ASL Medical Interpreter

• Provide in-person (IP) consecutive and simultaneous interpretation as assigned by dispatcher or requested by providers
• Provide consecutive interpretation via video or phone
• Provide sight translation following standard workflow and ethical guidelines
• Provide Short Translation of texts up to 5 lines for IP or Video Medical Interpretation (VMI) encounters
• Provide first draft translation or machine post-editing of AI translation into working languages
• Provide document alignment and proofreading services
• Mentor interns (beginning 6 months after date of hire at SHC)
• Mentor new hires (beginning one year after date of hire at SHC)
• Document encounters in electronic medical record (EMR) system according to departmental standards.

Chinese Medical Interpreter/Translator I

• Provide in-person consecutive and simultaneous interpretation as assigned
• Provide consecutive interpretation via video or phone
• Provide sight translation following standard workflow and ethical guidelines
• Provide Short Translation of texts up to 5 lines for IP or Video Medical Interpretation encounters
• Provide first draft translation or machine post-editing of AI translation
• Mentor interns and new hires
• Document encounters in electronic medical record (EMR) system

Spanish Medical Interpreter/Translator I

Technical Program Manager

• Responsible for managing the software development and delivery of patient-facing products and features
• Manage multiple projects concurrently, building cross-functional plans, budgeting, coordinating resources, managing issues
• Ensure timely delivery through the full software development life cycle, including launch and post-launch activities
• Facilitate Sprint Planning, Release Planning, Daily Stand-Ups, Product Demos and Sprint Retrospectives
• Support team in developing, maintaining and grooming Product Backlog
• Identify and manage dependencies with other internal or external teams
• Collaborate with scrum team and non-agile teams to align deliverables

Account Manager

• Accounts receivable collections and payer follow-up
• Payer denial review and appeals processing
• Payment posting and batch reconciliation
• Credit balance review and resolution
• Retroactive eligibility and registration
• Underpayment reconciliation
• Reviewing and analyzing payer variances, pursuing underpayments with payers as necessary

Patient Account Representative IV

• Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans
• Contacts patient as appropriate to obtain correct and updated information when necessary
• Completes Medicare Secondary Questionnaire as appropriate
• Applies authorization rules and requirements for all payors within the assigned work queues
• Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization

Patient Financial Clearance Representative I

Manager

• Manage the efficient and effective operations of pharmacy services.
• Supervise and manage associated personnel staff.
• Interprets and enforces established policies and procedures.
• Creates new policies and procedures.
• Designs and implements performance improvement initiatives that enhance safety, environmental, and infection control.
• Provides oversight to pharmacy personnel.
• Collaborates with the leadership team to improve services provided and assures compliance with regulatory requirements.
• Design, implement, and monitor pharmacy practices to optimize medication management outcomes for patients.
• Supervises and manages the technical support staff and staff clinical pharmacists.
• Partners across the organization to develop and implement solutions designed to improve member/client satisfaction; streamline processes between organizations for improved service delivery.
• Collaborates with physicians and other health care professionals to address issues related to patient drug therapy through the process of mutual information sharing, discussion, and decision making.
• Oversees training programs for pharmacy staff, residents, and students.

Manager, Home Infusion Pharmacy

Human Resources

• Provides hands-on care to patients in an evidence-based manner
• Performs all steps of the nursing process, including assessing patients and planning, implementing, and evaluating care
• Teaches patients and families the skills needed to manage care and prevent complications
• Collaborates with health care teams to develop individualized plans of care

Clinical Nurse, Oncology Infusion

• Provides hands-on care to patients practicing in an evidence-based manner
• Performs all steps of the nursing process, including assessing patients, interpreting data, planning, implementing, and evaluating care
• Coordinates care with other providers and teaches the patient and family the knowledge and skills needed to manage their care
• Partners with the patient's family to deliver family centered care
• Monitors the quality of nursing care provided
• Contributes to the profession of nursing through teaching others, sharing expertise, and maintaining professional development