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Director Patient Access/UR

Location:  Office Park (1644) 
Requisition #:  38770

JOB SUMMARY

Provides operational and strategic leadership and accountability for Utilization Management and front end revenue cycle activities in support of the system's mission and values. Obtain and validate patient demographic and insurance information needed to expedite reimbursement on Accounts Receivable while working closely with Physicians and Case Management to ensure quality and appropriateness of patient care and resource utilization management. Collaborate with Patient Accounts, Case Management, and IS&T Department to ensure verification, authorization, and denial management is in place. Function as the system resource and role model for revenue cycle functions including: scheduling, order management, admitting, pre-certification, authorization, and financial assistance/charity.

EDUCATION
  • Bachelor’s Degree in Nursing or Sciences or equivalent experience
CERTIFICATION SUMMARY
  • No professional certifications required
EXPERIENCE*
  • Minimum five years management experience in patient access and/or utilization review
PREFERRED QUALIFICATIONS*
  • MBA
KNOWLEDGE SKILLS & ABILITIES*
  • Demonstrated management skills and working knowledge of insurance industry pre-certification and utilization/case management criteria such as InterQual and/or Milliman
  • Must possess excellent communication, organizational, and interpersonal skills as well as aptitude for conflict resolution, problem solving, and staff development
  • Demonstrates the following skills in accomplishing job duties and responsibilities:
    • Personal organization and time management
    • Human relations and teamwork
    • Personal adaptability
    • Personal motivation
    • Listening
JOB RESPONSIBILITIES*
  1. Provide strategic direction and vision to optimize implementation of front end revenue cycle and utilization management for all hospital campuses and neighborhood locations.
  2. Provide oversight and promotion of quality of care, appropriateness of patient care, resource utilization management, and the development of policies and standards for the Utilization Management Program as co-chair of UM Committee and through collaboration with Medical Management.
  3. Develop and execute current Utilization Management Plan for the hospital campuses, ensuring ongoing compliance with state and federal regulations.
  4. Manage human and fiscal resources to improve system's revenue cycle cash receivables through implementation of an effective financial clearing program, accurate data collection, insurance verification, pre-certification, and authorization.
  5. Manage uninsured accounts receivables for the system through maintaining current knowledge of state, federal, and non-governmental available financial funding or resources, as well as developing professional partnerships. Implement Children's system-wide Financial Assistance/Charity policies and processes to ensure compliance with regulations as well as to improve organization growth and value in the community.
  6. Provide oversight for front-end actions necessitated by denials received through development and implementation of front-end revenue cycle policies for the system and partnership with physician practices, patient accounting, case management, HIM, coding, and IS&T.
  7. Provide leadership and direct system-wide education/training to all patient access areas (all hospital and neighborhood centers) to increase system-wide technical and operational knowledge of the dynamic and complex payor requirements and state and federal regulations for front-end revenue cycle activities.
  8. Indirectly provide leadership to all patient access areas which do not have direct reporting relationship or accountability.
SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

 

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

PHYSICAL DEMANDS*
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping - Occasionally (activity or condition exists up to 1/3 of time)
Climbing - Occasionally (activity or condition exists up to 1/3 of time)
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Constantly (activity or condition exists 2/3 or more of time)
Standing - Occasionally (activity or condition exists up to 1/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)
WORKING CONDITIONS*
No potential for exposure to blood and body fluids

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for fourteen consecutive years and named one of the “100 Best Companies” by Working Mother magazine. We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Address:  1644 Tullie Circle, Atlanta, GA  30329
Function:  Leadership/Management - Director/Senior Director


Nearest Major Market: Atlanta

Job Segment: Manager, Medical, Patient Care, Pediatric, Front End, Management, Healthcare, Technology