Manager Enterprise Authorization Services

To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Serves as the primary contact for coordinating and controlling all activities related to obtaining insurance prior authorization, and researching and analyzing denied services to ensure processes and workflows are created and implemented to minimize payment denials. Manages a team of authorization specialists responsible for insurance verification and the prior authorization of various assigned services. High School Diploma or Equivalent.
Five (5) years’ experience healthcare accounts receivables management, billing and collections.
Bachelor’s degree in Finance, Business Administration or related field.
Certified Healthcare Financial Professional (CHFP) with the Hospital Financial Management Association (HFMA).
Responsible for all aspects of managing and leading a team including: interviewing, hiring, training, developing, directing work processes, managing performance, managing time and attendance, and recognizing and rewarding employees.
Provides direct and timely communication to Departmental Directors and Clinic Administrators regarding revenue risks within their departments. Participates in process design that will mitigate identified risks.
Reviews and manages productivity and timeliness of authorization and Develops/implements action plans appropriately. Stays abreast of updates and changes to regulatory billing updates, regulatory requirements and organizational compliance policies to avoid audits and appeals/denials
Manages and regularly audits the work of all Authorization staff to ensure high quality and productivity. Monitor and track staff compliance regarding timeliness of obtaining authorizations and treatment plan submission to ensure ongoing attention to timely processing accounts
Monitors data trends relating to insurance authorization and reimbursement and reports on such to Director
Identifies process improvement opportunities and develops, implements, monitors and revises action plans.
Anticipates and proposes opportunities to improve current technology to enhance performance and productivity.
Maintains a good working knowledge of authorization requirements for all payors and state/federal regulatory guidelines for coverage and authorization of outpatient services
Oversees pre-certification requirements for assigned services to create and implement necessary workflows and processes to improve system reimbursement.
Uses data analysis related to Denial Management metrics to monitor progress on denial and looks for process initiatives.
Works closely with hospital billing, professional billing, Outpatient Registration and Revenue Cycle in monitoring data trends relating to insurance authorization and reimbursement and handles complex denials. Manages the functions of the assigned hospitals to ensure timely review, and facilitates the front end appeals through peer to peer.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Considerable knowledge of computers and the use/manipulation/application of data in support of administrative functions.
Knowledge of EPIC system is preferred.
Knowledge of Medicare, Medicaid and other regulatory requirements.
Commercial Medicare, Medicaid, HMO, PPO, etc.) grievance procedures and utilization management processes required.
Knowledge of managed care, inpatient and outpatient care, utilization management, Interqual criteria.
Knowledge of the operations of patient billing is required.
Knowledge of medical terminology and the ability to interpret information in the medical record is required.
Previous experience in administrative or supervisory role.
Ability to function as a team player and support of colleagues and staff is essential.
Ability to hold others accountable to performance related to lost revenue due to denials.
40 Shift:
536 SYSTEM Hospital Authorization Unit