The Carle Foundation
Manager of Medical Insurance/Central Prior Authorization
The Carle Foundation, Champaign, Illinois, us, 61825
Manager of Medical Insurance/Central Prior Authorization
Department:
Registration Center - CFH_10_19Usual Schedule:
8a-5pRegions:
Carle FoundationOn Call Requirements:
N/AJob Category:
ManagementWork Location:
Carle Foundation HospitalEmployment Type:
Full - TimeJob Post ID:
45061Experience Requirements:
1 - 3 Years
Job Description
JOB SUMMARY:Manages the daily activities of Patient Access Medical Insurance and Prior Authorization departments to ensure high quality customer service and improve revenue cycle activities for prior authorizations, documentation, billing and claims. Understands regulatory and third party payer guidelines for admissions, discharges, ambulatory visits, diagnostic imaging, inpatient and outpatient services, billing, to ensure authorization functions and staff remain in regulatory compliance. Reviews SVR (Staffing Variance Reporting) to ensure that budget guidelines are met, and to provide appropriate resources based on the department volumes and activities.
Oversees training, education, and staff development by department supervisor, leads, and trainers. Promotes cross training and develops staff to enhance job function and responsibilities so that maximum flexibility within Patient Access is achieved. Coordinates and communicates process updates and flows with internal departments at Carle and external departments when necessary, to ensure that Prior Authorizations are in place by the patient's service date to increase patient satisfaction, reimbursement to the organization, and problem resolution. Takes an active role in denials reduction efforts, timely filing expectations for registration and authorization claim error resolution, and serves as a SME (Subject Matter Expert) for Revenue Cycle operations for registration and authorizations.
EDUCATIONAL REQUIREMENTSBachelor's Degree in Business or Science
CERTIFICATION & LICENSURE REQUIREMENTSCertified Healthcare Access Manager (CHAM) within 2 years.
EXPERIENCE REQUIREMENTSSystems experience (preferably EPIC) with registration, referrals, authorizations, and billing/claims.Ability to successfully manage a Patient Access department with multiple applications, including multiple EMR systems.Analytical skills necessary to collect, analyze data, identify problems, research regulatory topics, interpret federal regulation.Develop meaningful solutions and recommendations.Organizational skills and abilitiesManage a range of projects to daily operations, coordinate multiple projects simultaneouslyMultitasking while implementing regulations and guidelines to monitor outcomes and actions.Microsoft Office proficiency necessary.Strong communication skills, both written and verbalAbility to manage both on and offsite employees, and remote work from home staff.
ESSENTIAL FUNCTIONS:Continuously streamlines processes/systems to achieve maximum effectivenessEnsures employees are properly oriented and trained in operations and equipmentEnsures annual competencies and certifications, licensures and education requirements are correctEnsures the accuracy and completeness of patient information entered into the EMR systemMaintains payroll to ensure accuracy of man hours.Manages daily activities of the Medical Insurance and Prior Authorization departmentsEnsure quality and quantity of work is maintainedEnsure patient authorizations is properly communicated in a timely mannerOperates departments in a cost-effective manner by monitoring labor hours, supply expenses, and volumes.Ensures adequate staffing levels are maintained to provide timely patient service and submission of authorizationsPerforms department audits and identify authorization errorsEnforces various organizational policies consistentlyProvides continuous written and verbal feedback to staff and management regarding audit outcomesAssigns and delegates tasks as needed in the absence of employees so workflow is maintainedWorks closely with OR/Med Surgical leadership, ASC (Ambulatory Surgical Center) leadership, Revenue Cycle leadership, Specialty department leadership, Patient Financial Services, Inpatient Case Coordination services, Information Technology, payer contracting.Facilitates and communicates necessary changes to appropriate department leadership to improve processes.Performs high level of patient service from all areas of responsibility.Assist staff with patient service and insurance service issuesUtilizes Payer Contracting and Insurance Payer Representatives when neededMaintains active involvement with all regulatory compliance functionsMaintains up to date working knowledge of latest healthcare trends in authorization, insurance verification and benefits, reimbursement, claims denials, and hospital/clinical managementIdentifies, discusses, plans and implements processes that align with state and government regulations as neededMonitor and analyze workflows and processesEnsure operations of registration, authorization, financial counseling, pre-service estimations and collections, etc.Lead employees in The Carle Experience with accountability of expectations by mentoring, coaching, discipline, etc.Perform audits to identify authorization errors while providing feedback to employeesPerforms audits - (i.e. WQ audits, documentation audits, Voicecert/Pixcert audits, WQ audits)Interview, hire, and onboard new employees with the assistance of department supervisors and peer interviewers, with a 90 day process as well as evaluations for new / existing employeesAdhere to all leadership expectations of the Carle Experience through rounding, AIDET audits, Patient Experience scores, as well as benchmarking and 90 day action plansManages budget and productivity targets within the department
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com . Positions are not available for remote work in the state of Colorado.Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for Medical or Religious exemption will be permitted.
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Department:
Registration Center - CFH_10_19Usual Schedule:
8a-5pRegions:
Carle FoundationOn Call Requirements:
N/AJob Category:
ManagementWork Location:
Carle Foundation HospitalEmployment Type:
Full - TimeJob Post ID:
45061Experience Requirements:
1 - 3 Years
Job Description
JOB SUMMARY:Manages the daily activities of Patient Access Medical Insurance and Prior Authorization departments to ensure high quality customer service and improve revenue cycle activities for prior authorizations, documentation, billing and claims. Understands regulatory and third party payer guidelines for admissions, discharges, ambulatory visits, diagnostic imaging, inpatient and outpatient services, billing, to ensure authorization functions and staff remain in regulatory compliance. Reviews SVR (Staffing Variance Reporting) to ensure that budget guidelines are met, and to provide appropriate resources based on the department volumes and activities.
Oversees training, education, and staff development by department supervisor, leads, and trainers. Promotes cross training and develops staff to enhance job function and responsibilities so that maximum flexibility within Patient Access is achieved. Coordinates and communicates process updates and flows with internal departments at Carle and external departments when necessary, to ensure that Prior Authorizations are in place by the patient's service date to increase patient satisfaction, reimbursement to the organization, and problem resolution. Takes an active role in denials reduction efforts, timely filing expectations for registration and authorization claim error resolution, and serves as a SME (Subject Matter Expert) for Revenue Cycle operations for registration and authorizations.
EDUCATIONAL REQUIREMENTSBachelor's Degree in Business or Science
CERTIFICATION & LICENSURE REQUIREMENTSCertified Healthcare Access Manager (CHAM) within 2 years.
EXPERIENCE REQUIREMENTSSystems experience (preferably EPIC) with registration, referrals, authorizations, and billing/claims.Ability to successfully manage a Patient Access department with multiple applications, including multiple EMR systems.Analytical skills necessary to collect, analyze data, identify problems, research regulatory topics, interpret federal regulation.Develop meaningful solutions and recommendations.Organizational skills and abilitiesManage a range of projects to daily operations, coordinate multiple projects simultaneouslyMultitasking while implementing regulations and guidelines to monitor outcomes and actions.Microsoft Office proficiency necessary.Strong communication skills, both written and verbalAbility to manage both on and offsite employees, and remote work from home staff.
ESSENTIAL FUNCTIONS:Continuously streamlines processes/systems to achieve maximum effectivenessEnsures employees are properly oriented and trained in operations and equipmentEnsures annual competencies and certifications, licensures and education requirements are correctEnsures the accuracy and completeness of patient information entered into the EMR systemMaintains payroll to ensure accuracy of man hours.Manages daily activities of the Medical Insurance and Prior Authorization departmentsEnsure quality and quantity of work is maintainedEnsure patient authorizations is properly communicated in a timely mannerOperates departments in a cost-effective manner by monitoring labor hours, supply expenses, and volumes.Ensures adequate staffing levels are maintained to provide timely patient service and submission of authorizationsPerforms department audits and identify authorization errorsEnforces various organizational policies consistentlyProvides continuous written and verbal feedback to staff and management regarding audit outcomesAssigns and delegates tasks as needed in the absence of employees so workflow is maintainedWorks closely with OR/Med Surgical leadership, ASC (Ambulatory Surgical Center) leadership, Revenue Cycle leadership, Specialty department leadership, Patient Financial Services, Inpatient Case Coordination services, Information Technology, payer contracting.Facilitates and communicates necessary changes to appropriate department leadership to improve processes.Performs high level of patient service from all areas of responsibility.Assist staff with patient service and insurance service issuesUtilizes Payer Contracting and Insurance Payer Representatives when neededMaintains active involvement with all regulatory compliance functionsMaintains up to date working knowledge of latest healthcare trends in authorization, insurance verification and benefits, reimbursement, claims denials, and hospital/clinical managementIdentifies, discusses, plans and implements processes that align with state and government regulations as neededMonitor and analyze workflows and processesEnsure operations of registration, authorization, financial counseling, pre-service estimations and collections, etc.Lead employees in The Carle Experience with accountability of expectations by mentoring, coaching, discipline, etc.Perform audits to identify authorization errors while providing feedback to employeesPerforms audits - (i.e. WQ audits, documentation audits, Voicecert/Pixcert audits, WQ audits)Interview, hire, and onboard new employees with the assistance of department supervisors and peer interviewers, with a 90 day process as well as evaluations for new / existing employeesAdhere to all leadership expectations of the Carle Experience through rounding, AIDET audits, Patient Experience scores, as well as benchmarking and 90 day action plansManages budget and productivity targets within the department
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com . Positions are not available for remote work in the state of Colorado.Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for Medical or Religious exemption will be permitted.
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