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Manager Hospital Authorization

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Date: Nov 10, 2017

Location: Atlanta, GA, US, 30329

Company: Children's Healthcare of Atlanta

Requisition #:  17502     
Name of Location:   Office Park (1644)
Work Schedule:  Variable
Employment Type:  Full-Time
Work Days:  Monday - Friday; Saturday; Sunday; Variable 

JOB SUMMARY

Serves as primary contact for coordinating and controlling all activities related to obtaining insurance eligibility, benefits, verification, prior authorization, and researching and analyzing denied services to ensure processes and workflows are created and implemented to meet financial objectives. Maintains working knowledge of all hospital authorization requirements and manages a team of verifiers and schedulers responsible for order indexing, scheduling, and pre-registration of patients for medical services, insurance verification, and the prior authorization of Radiology, Ambulatory Surgery, Rehabilitation Services, multi-specialty clinics, and planned in-patient admissions.

EDUCATION

  • Bachelor’s degree

CERTIFICATION SUMMARY

  • No professional certifications required

EXPERIENCE*

  • 5 years of experience in a supervisory role in a healthcare-related area with a focus in hospital authorization

PREFERRED QUALIFICATIONS*

  • Experience in change management, including leading teams during system implementations and upgrades                                    
  • Certified Healthcare Financial Professional (CHFP), Certified Patient Account Representative (CPAR), or Certified Healthcare Access Manager (CHAM)

KNOWLEDGE SKILLS & ABILITIES*

  • Knowledge of hospital accounts receivable functions
  • Knowledge of medical terminology and CPT-4 and ICD-10
  • Must possess and demonstrate excellent written and oral communication, organizational, and interpersonal skills
  • Must be able to train and supervise personnel and work well with other managerial staff
  • Proven aptitude for problem-solving and critical thinking
  • Must be able to apply basic verbal and non-verbal communication to identify and reduce patient and family/friends anxiety and concerns

JOB RESPONSIBILITIES*

  1. Maintains a good and working knowledge of hospital authorization requirements for all payors and state/federal regulatory guidelines for coverage and authorization of hospital services.
  2. Manages and coordinates a centralized verification team and clinical support staff responsible for obtaining  authorization for hospital services by providing required clinicals and follow-ups to insurance payors, directly impacting system reimbursement goals.
  3. Manages a centralized scheduling team for outpatient rehabilitation services to ensure quality and financial  objectives are achieved.
  4. Establishes and meets desired outcomes that measure quality, cost, and service which are consistent with Children's Healthcare of Atlanta goals.
  5. Analyzes front-end denial trends to determine resolution for aggregate performance.
  6. Monitors managed care trends and pre-certification requirements to create and implement necessary workflows and processes to improve system reimbursement.
  7. Utilizes all statistical and financial reports as tools to analyze and direct departmental operations.
  8. Serves as key contact for central training, continuing education, and development for all verification staff in the system.
  9. Maintains quality control programs, including reviews of denial information as appropriate in the Patient Access department.
  10. Validates information system implementations and ensures upgrades are completed successfully in conjunction with Information Systems & Technology and other areas/departments as needed. 
  11. Supports Director, Patient Access in implementing and achieving revenue cycle goals and initiatives.
  12. Recommends space and other services needed by the Patient Access department.
  13. Participates in activities associated with applicable payor/vendor contract negotiations as necessary.
  14. Ensures staff/department attainment of any required credentials/licenses and plan/professional documentation.
  15. Allocates staff to quickly respond to volumes and patient/family needs.
  16. Tracks volumes and turnaround times to ensure ongoing attention to timely processing.
  17. Supports the mission, vision, and values of Children’s Healthcare of Atlanta and the department.
  18. Monitors full-time employee usage and adjusts staffing levels accordingly, helping to meet departmental budget.
  19. Responsible for all aspects of managing and leading a team including: interviewing, hiring, training, developing, directing work and processes, managing performance, recognizing, and rewarding employees.
  20. Mentor team members to encourage personal and professional growth.
  21. Encourage ongoing skill development by providing opportunities for continued education.

 

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 - Frequently (activity or condition exists from 1/3 to 2/3 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*

Some potential for exposure to blood and body fluids

 

 

Location Address:  1644 Tullie Circle, Atlanta, GA  30329
Function:  Revenue Cycle - Patient Financial Services

 

Overview:

Children’s Healthcare of Atlanta has been 100 percent dedicated 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 622 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 60 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 twelve 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 being Dedicated to All Better and impact the lives of hundreds of thousands of patients and their families each year.


Nearest Major Market: Atlanta

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