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. Overseeallpre-arrivaloperations,includingbutarenotlimitedtopre-registration,insuranceverification,securing authorizations,patientestimates,pricetransparency,billing,preandpostclaimedits,anddenials forhospitaland physician services.
2. Analyzeplannedandsentineleventstodevelopstrategiesfor improvement and routinelyevaluateindustryandmarketforcestoproviderecommendationsfornewand/orevolving business development and/or improvement in efficiency and effectiveness of operations.
3.Managesongoingoperationalevaluation,reportingtometricsandstandardsconsistentwithestablishedgoalsand target outcomes, and driveforminimizedpatientdelayandcancellationsasprocessesfailurepointswhicharetobeprevented.
4.Evaluationofthecurrentfinancialclearancetechnologystacktoprovidestrategicguidanceforenhancingthe 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, analyzesstaffingneeds;performscost/benefitanalysesasappropriate;plansandestimatesfuturecostsincludingcapital expenditures asappropriate; justifies requests for equipment and staff.
7.CoordinatewithClinicalDepartmentleaderstocommunicateAuthorization's supportmodelandscopetoplanforthe transition of services when mutually agreed upon
8. Develop,monitor,andreportmetrics.Setgoalsandobjectives, Developandimplementprocessesandprocedurestoreachandexceedgoals, and Activelyparticipateandcollaborateamongentitiesanddepartmentspromotingperformance improvement and patientsatisfaction.
9.Develops,recommends,revisesandimplementspoliciesandproceduresforassignedprogramsandservicestoensuretheir consistency with hospital standards and requirements.
10.Developeffectiveinternalcontrolsthatpromoteadherencetoapplicablestate/federallaws,andtheprogram requirements of accreditation agencies and federal,stateand private health plans.
11.Selects,trains,evaluates,andcounselsmanagementpersonnelfosteringapositive,supportiveculturethatminimizes employee turnover and establishes departmental goals and priorities
12.Createandmaintainworkplansprovidingtimelyandrelevantfeedbacktosupervisorsand employees. 13.Collaboratewithclinicaladministrators,clinicaldepartments,hospitaladministration,medicalstaffandallotherkey enterprisestake holdersto enhance patient satisfaction and effectiveness of the pre-arrival services.

Other information:

Technical Expertise

1.Workingknowledgeofmanagedcare,(i.e.Medicare,Medicaid,Anthemothercommercialpayorsandallrelated federal and state regulations and requirements)

2. Knowledgeofgovernmentandinsurancepayorsadmissionandbillingregulations 3.Abilitytolearnandworkwithvariouscomputersoftwareprogramsaswellastheabilitytomanagesoftwareprojects.
4. Preferred: Provenleadershipexperiencedevelopingand 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