Manager of Medical Insurance/Central Prior Authorization

Department: Registration Center - CFH1019

Entity: Champaign-Urbana Service Area

Job Category: Management

Employment Type: Full - Time

Job ID: 45061

Experience Required: 1 - 3 Years

Education Required: Bachelors Degree

Shift: Day

Location: Remote

Usual Schedule: 8a-5p

On Call Requirements: N/A

Work Location: Carle Foundation Hospital

Weekend Requirements: N/A

Holiday Requirements: N/A

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Position 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.

Qualifications:

EDUCATIONAL REQUIREMENTS

Bachelor's Degree in Business or Science

CERTIFICATION LICENSURE REQUIREMENTS

Certified Healthcare Access Manager (CHAM) within 2 years.

EXPERIENCE REQUIREMENTS

Systems 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 abilities

Manage a range of projects to daily operations, coordinate multiple projects simultaneously

Multitasking while implementing regulations and guidelines to monitor outcomes and actions.

Microsoft Office proficiency necessary.

Strong communication skills, both written and verbal

Ability to manage both on and offsite employees, and remote work from home staff.

Essential Functions:

Continuously streamlines processes/systems to achieve maximum effectiveness

Ensures employees are properly oriented and trained in operations and equipment

Ensures annual competencies and certifications, licensures and education requirements are correct

Ensures the accuracy and completeness of patient information entered into the EMR system

Maintains payroll to ensure accuracy of man hours.

Manages daily activities of the Medical Insurance and Prior Authorization departments

Ensure quality and quantity of work is maintained

Ensure patient authorizations is properly communicated in a timely manner

Operates 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 authorizations

Performs department audits and identify authorization errors

Enforces various organizational policies consistently

Provides continuous written and verbal feedback to staff and management regarding audit outcomes

Assigns and delegates tasks as needed in the absence of employees so workflow is maintained

Works 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 issues

Utilizes Payer Contracting and Insurance Payer Representatives when needed

Maintains active involvement with all regulatory compliance functions

Maintains up to date working knowledge of latest healthcare trends in authorization, insurance verification and benefits, reimbursement, claims denials, and hospital/clinical management

Identifies, discusses, plans and implements processes that align with state and government regulations as needed

Monitor and analyze workflows and processes

Ensure 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 employees

Performs 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 employees

Adhere to all leadership expectations of the Carle Experience through rounding, AIDET audits, Patient Experience scores, as well as benchmarking and 90 day action plans

Manages budget and productivity targets within the department

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. 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: [email protected].

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.