Full-time, 40 hours/week
Monday-Friday 8am-4:30pm
Hybrid remote (2-3 days/week onsite)
Summary:
The Manager Authorizations is responsible for the overall management of pre-arrival operations for the ACH, including strategic planning, capital and operational budgeting, financial analysis, key metric development and management, regulatory compliance, problem resolution, personnel management, performance improvement, and system improvement and optimization. Pre-Arrival operations may include, but are not limited to pre-registration, insurance verification, securing authorizations, patient estimates, price transparency, billing, pre and post claim edits, denials for hospital and physician services, and pre-authorization.
Responsibilities:
1. Oversee� all� pre-arrival� operations,� including� but� are� not� limited� to� pre-registration,� insurance� verification,� securing authorizations,� patient� estimates,� price� transparency,� billing,� pre� and� post� claim� edits,� and� denials for� hospital� and physician services.
2. Analyze� planned� and� sentinel� events� to� develop� strategies� for improvement and routinely� evaluate� industry� and� market� forces� to� provide� recommendations� for� new� and/or� evolving business development and/or improvement in efficiency and effectiveness of operations.
3.� Manages� ongoing� operational� evaluation,� reporting� to� metrics� and� standards� consistent� with� established� goals� and target outcomes, and drive� for� minimized� patient� delay� and� cancellations� as� processes� failure� points� which� are� to� be� prevented.
4.� Evaluation� of� the� current� financial� clearance� technology� stack� to� provide� strategic� guidance� for� enhancing� the streamlined processing of accounts.
5. Oversee Leaders who manage Authorizations team processes and workflow to ensure 100% of account accuracy of patient demographics, all required account fields, validation and verification of insurance coverages, authorizations and patient contact and pre-service collections.
6. Prepares and administers assigned budgets; monitors, evaluates and approves expenditures within limits of authority, analyzes� staffing� needs;� performs� cost/benefit� analyses� as� appropriate;� plans� and� estimates� future� costs� including� capital expenditures as� appropriate; justifies requests for equipment and staff.
7.� Coordinate� with� Clinical� Department� leaders� to� communicate� Authorization's support� model� and� scope� to� plan� for� the transition of services when mutually agreed upon
8. Develop,� monitor,� and� report� metrics.� Set� goals� and� objectives, Develop� and� implement� processes� and� procedures� to� reach� and� exceed� goals, and Actively� participate� and� collaborate� among� entities� and� departments� promoting� performance improvement and patient� satisfaction.
9.� Develops,� recommends,� revises� and� implements� policies� and� procedures� for� assigned� programs� and� services� to� ensure� their consistency with hospital standards and requirements.
10.� Develop� effective� internal� controls� that� promote� adherence� to� applicable� state/federal� laws,� and� the� program requirements of accreditation agencies and federal,� state� and private health plans.
11.� Selects,� trains,� evaluates,� and� counsels� management� personnel� fostering� a� positive,� supportive� culture� that� minimizes employee turnover and establishes departmental goals and priorities
12.� Create� and� maintain� work� plans� providing� timely� and� relevant� feedback� to� supervisors� and employees.
13.� Collaborate� with� clinical� administrators,� clinical� departments,� hospital� administration,� medical� staff� and� all� other� key enterprise� stake holders� to enhance patient satisfaction and effectiveness of the pre-arrival services.�
Other information:
Technical Expertise
1.� Working� knowledge� of� managed� care,� (i.e.� Medicare,� Medicaid,� Anthem� other� commercial� payors� and� all� related federal and state regulations and requirements)
2. Knowledge� of� government� and� insurance� payors� admission� and� billing� regulations�
3.� Ability� to� learn� and� work� with� various� computer� software� programs� as� well� as� the� ability� to� manage� software� projects.
4. Preferred: Proven� leadership� experience� developing� and implementing functional operations plans.
Education and Experience
1. Education: Bachelor's degree in Business Administration or related field required
2.� Years of relevant experience: 5 years progressive supervisory/management experience in hospital revenue cycle and patient access departments
Full Time
FTE: 1.000000
Status: Fixed Hybrid