TRC - Clinical Services Manager

Clinical Services Manager

Day-to-day responsibility and oversight for the assigned clinics. Ensures that provider productivity is maximized through efficiencies in scheduling and patient flow. Provides the necessary guidance and support to enable clinical staff to meet the complex needs of the patients. Provides assistance and support to members of the management team in the areas of reimbursement, credentialing, quality assurance and compliance. Ensures all regulatory compliance is met.

Must possess strong leadership skills and abilities in order to guide and support a diverse workforce; Must possess strong interpersonal skills in order to successfully navigate within and outside of the service environment; Must possess an awareness of all applicable state and federal regulations and funding stream opportunities and requirements; Must possess a comprehensive knowledge of medical office procedures (i.e. coding, billing, and scheduling); Ability to work under pressure is helpful; Must possess strong administrative, organizational, time management, and recordkeeping skills; Must be self-directed and able to initiate and manage multiple responsibilities effectively and efficiently; Excellent verbal and written communication skills across various channels is paramount; Must be flexible and willing to work non-traditional hours as needed or assigned to meet the needs of professional staff and/or patients; Physical condition commensurate with the demands of the job.

Associates degree in Medical Office Technology, Business Administration, or related field, plus two (2) years of medical office experience OR High School diploma/GED plus four (4) years of medical office experience. Proven experience in working with individuals with developmental disabilities, patient registration, and/or medical billing is strongly preferred. Valid driver's license, use of a personal vehicle, and willingness to travel for work is required.

The required Lominger Leadership Architect competencies include, but are not limited to:

Approachability - Decision Quality - Managing Diversity

Building Effective Teams - Delegation - Motivating Others

Comfort Around Higher Management - Directing Others - Negotiating

Command Skills - Drive for Results - Priority Setting

Composure - Informing - Problem Solving

Conflict Management - Integrity and Trust - Process Management

Customer Focus - Learning on the Fly - Time Management

Dealing with Ambiguity - Managing and Measuring Work - Timely Decision Making

The successful incumbent will also dedicate additional attention and energy on the following Lominger skill areas:

Operating Skills(i.e. Keeping on Point, Getting Organized, Getting Work Done Through Others, and Managing Work Processes) - Personal and Interpersonal Skills(i.e. Inspiring Others, Managing Diverse Relationships, Relating Skills, Being Open and Receptive, and Acting with Honor and Character)

Strategic Skills(i.e. Making Complex Decisions, and Creating the New and Different) - Courage(i.e. Dealing with Trouble)

Energy and Drive(i.e. Focusing on the Bottom Line) - Organizational Positioning Skills(i.e. Managing Up).

Responsible for providing administrative supervision of assigned staff including but not limited to:

1. Hiring, firing, discipline, performance evaluation, in-service education and training, and ensuring that there are an adequate number of staff to fulfill assigned responsibilities.
2. Approves staff schedules, ensuring sufficient staffing for the department.
3. Coordinates staff orientation with the Training Department and ensures new hires and regular staff receive ongoing trainings, including review and evaluation of travel training requests and tracking of Continuing Education Units (CEU).
4. Oversees all aspects of the workforce including timely completion of new hire paperwork, disciplinary actions and other personnel related matters.
5. Ensures compliance with annual TRC and/or regulatory training requirements, including but not limited to flu shots, Mantoux screening, and health screening).
6. Conducts staff meetings as needed or assigned.

Ensures that duties performed by assigned staff adhere to Federal and State laws and regulations governing clinical services, HIPAA standards, and TRC policy and procedure.

Monitors day-to-day patient scheduling in order to maximize provider productivity, making adjustments to staffing as needed.

Ensures that all clinic staff utilizes proper coding for all services rendered.

Ensures timely and accurate documentation and billing for all services rendered.

Assumes day-to-day responsibility for assisting in fiscal matters in the clinic including, but not limited to:

1. Assists in monitoring expenses to ensure that they are within budgeted parameters.
2. Monitors, reviews, and corrects errors in invoices as necessary.
3. Processes all clinic co-pays and submit to Finance for posting on a weekly basis
4. Oversight and maintenance of cash drawers and petty cash
5. Reduces and/or maintains current cost of clinical supplies for clinic by locating suppliers with quality goods at reduced cost.
6. Meets with sales representatives, sets up accounts, places orders, keeps track of inventory, invoices, etc., consistent with TRC purchasing policies and procedures.

Addresses patient complaints/concerns involving clinical personnel and provides proper follow-up, as needed.

Serves as liaison between Clinical Services and other agency Management by regularly keeping them informed of issues/problems affecting day-to-day operations and works with team to address/correct such issues/problems.

Represents Clinical Services at various meetings, either within or outside of the organization, as needed or assigned.

Facilitates designated clinic staff meetings and assumes responsibility for completion and distribution of meeting minutes.

Creates reports for various Steering, Quality, Board and other areas as needed and assigned

Implements Quality improvement practices

Builds capacity and ensures maximization of reimbursement through effective utilization of integrated service delivery system.

Responsible for data tracking and management of data across systems, including but not limited to, the Accountable Care Organization (ACO).

Responsible for ensuring compliance with insurance reimbursement activities, including, but not limited to:

1. Ensuring staffs timely and accurate completion/submission of necessary insurance requirements.
2. Tracking of authorizations for patients with third-party or managed care insurance(s).
3. Reviewing denials and related work flows minimize denials.
4. Maintaining current knowledge of requirements of various insurance requirements/regulations and ensuring clinical staff compliance.
5. Ensuring the department is receiving proper reimbursement for services provided, in conjunction with the fiscal services team.

Ensure providers are credentialed, appointed, and privileged with all health plans

• prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges.
• ensure that all information meets federal and state guidelines when processing applications.
• Maintain up-to-date data for each provider in credentialing databases and any online systems
• regularly complete and submit staff credentialing or re-credentialing applications to the appropriate agencies and track when certifications are due to expire.
• overseeing the auditing of a facility or individual practitioner.
• Review and verify all credentialing applications prior to submission to the Board of Directors and Credentialing source
• Maintains provider information in an online credentialing or other system.
• Track license and certification expirations for all providers to ensure timely renewals.
• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• In conjunction with Human resources:
• Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Maintain corporate provider contract files.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Audits health plan directories for current and accurate provider information.
• Maintains confidentiality of provider information.
• Provides credentialing and privileging verifications.

Assists clinicians by maintaining and tracking patient/consumer reports (i.e., 90-day progress reports, evaluations, etc.) and ensures timely completion of same.

Develops and ensures adherence to appropriate schedule templates to ensure maximum productivity of clinicians assigned to the Clinic site and assists in the monitoring of clinician utilization and productivity.

Responsible for assisting in referral activities with the Clinic site, including, but