Manager Authorizations

Full-time, 40 hours/week

Monday-Friday 8am-4:30pm

Hybrid remote (2-3 days/week onsite)

Summary:

The Manager Authorizations is responsible for the overall management of pre-arrival operations for the ACH, including strategic planning, capital and operational budgeting, financial analysis, key metric development and management, regulatory compliance, problem resolution, personnel management, performance improvement, and system improvement and optimization. Pre-Arrival operations may include, but are not limited to pre-registration, insurance verification, securing authorizations, patient estimates, price transparency, billing, pre and post claim edits, denials for hospital and physician services, and pre-authorization.

Responsibilities:

1. Oversee all pre-arrival operations, including but are not limited to pre-registration, insurance verification, securing authorizations, patient estimates, price transparency, billing, pre and post claim edits, and denials for hospital and physician services.

2. Analyze planned and sentinel events to develop strategies for improvement and routinely evaluate industry and market forces to provide recommendations for new and/or evolving business development and/or improvement in efficiency and effectiveness of operations.

3. Manages ongoing operational evaluation, reporting to metrics and standards consistent with established goals and target outcomes, and drive for minimized patient delay and cancellations as processes failure points which are to be prevented.

4. Evaluation of the current financial clearance technology stack to provide strategic guidance for enhancing the streamlined processing of accounts.

5. Oversee Leaders who manage Authorizations team processes and workflow to ensure 100% of account accuracy of patient demographics, all required account fields, validation and verification of insurance coverages, authorizations and patient contact and pre-service collections.

6. Prepares and administers assigned budgets; monitors, evaluates and approves expenditures within limits of authority, analyzes staffing needs; performs cost/benefit analyses as appropriate; plans and estimates future costs including capital expenditures as appropriate; justifies requests for equipment and staff.

7. Coordinate with Clinical Department leaders to communicate Authorization's support model and scope to plan for the transition of services when mutually agreed upon

8. Develop, monitor, and report metrics. Set goals and objectives, Develop and implement processes and procedures to reach and exceed goals, and Actively participate and collaborate among entities and departments promoting performance improvement and patient satisfaction.

9. Develops, recommends, revises and implements policies and procedures for assigned programs and services to ensure their consistency with hospital standards and requirements.

10. Develop effective internal controls that promote adherence to applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.

11. Selects, trains, evaluates, and counsels management personnel fostering a positive, supportive culture that minimizes employee turnover and establishes departmental goals and priorities

12. Create and maintain work plans providing timely and relevant feedback to supervisors and employees.

13. Collaborate with clinical administrators, clinical departments, hospital administration, medical staff and all other key enterprise stake holders to enhance patient satisfaction and effectiveness of the pre-arrival services.

Other information:

Technical Expertise

1. Working knowledge of managed care, (i.e. Medicare, Medicaid, Anthem other commercial payors and all related federal and state regulations and requirements)

2. Knowledge of government and insurance payors admission and billing regulations

3. Ability to learn and work with various computer software programs as well as the ability to manage software projects.

4. Preferred: Proven leadership experience developing and implementing functional operations plans.

Education and Experience

1. Education: Bachelor's degree in Business Administration or related field required

2. Years of relevant experience: 5 years progressive supervisory/management experience in hospital revenue cycle and patient access departments

Full Time

FTE: 1.000000

Status: Fixed Hybrid