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Company: MedStar Medical Group
Location: Columbia, MD
Career Level: Mid-Senior Level
Industries: Not specified
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Description

General Summary of Position
Supervises and coordinates the daily activities of Patient Access & Central Financial Clearance with the overall operations of the assigned department. in conjunction with management, monitors and supports pre-authorization and pre-certification workflows, ensuring that representatives are completing expected quality and productivity goals. Establishes priorities, schedules, distributes work, and reassigns tasks as necessary to prevent denials. Provides team members with opportunities for learning, creativity, and personal growth. Works with all team members to resolve authorization, clearance, and customer service issues with both internal and external customers.


Primary Duties and Responsibilities


  • Supervises and oversees the verification of eligibility and pre-authorization processes. Ensures staff obtains required pre-visit clearance, referrals and authorizations as per payer requirements, matrices, and managed care contracts.
  • Oversees necessary authorization and clearance reports and workqueues. Ensures that all documentation is accurate and available in the EHR, physician and facility billing systems. Monitors escalation activity in assigned channels. Supervises the review and analysis of outstanding authorizations and clearance.
  • Supervises the day-to-day activities of assigned staff in conjunction with management to accomplish established goals. Establishes priorities, schedules, distributes work and reassigns tasks as necessary. Investigates, monitors and consults with management and makes recommendations to address untimely processing of reports and/or tasks.
  • Tracks error rates in authorization submissions, ensures quality assurance for eligibility verification and authorizations, and supports staff in meeting benchmarks for timely submission and denial management.
  • Ensure that systems, including but not limited to IDX, SMS/Invision,and MedConnect, have correct and detailed authorization data and documentation to facilitate accurate billing. Ensures cross-training on systems to keep staff updated on system changes that impact pre-authorization and eligibility workflows.
  • Conducts regular audits on accounts assigned. Identifies trends and/or problems and assists the leader with recommendations based on findings to improve staff effectiveness. Communicates with provider offices regarding issues or recommendations.
  • Assists with the development of financial, operational and productivity targets. Supervises and effectively uses resources to achieve financial, operational, and reduced denial targets in conjunction with management.
  • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and payer requirements. Maintain effective communication with insurance companies for troubleshooting, understanding regulatory changes, and overseeing the resolution of authorization-related issues.
  • Conducts formal performance reviews and provides feedback to team members in accordance with Human leader Resource Personnel Assessment guidelines. Orients new associates to department policies and procedures. Provides timely and appropriate counseling of personnel when they deviate from department standards. Evaluates all staff after ninety days of employment and annually thereafter. Works with staff in a timely manner to improve, track, and develop areas of poor performance.
  • Supervises team members by empowering, coaching, answering questions, giving guidance, and leading by example. Provides team members with opportunities for learning, creativity and personal growth.
  • Hires and retains appropriate and qualified personnel to perform the functions and services of the department. Demonstrates appropriate interviewing skills and knowledge of employment laws.<
  • Accountable for securing information over the phone from patient or insurance company including precollection and preregistration on accounts.
  • Maintains ongoing knowledge of UB04, and other mandatory state billing forms and filing requirements. Monitors the ACD Line including reporting and assisting with answering the incoming calls as needed.
  • Monitors, investigates, and resolves outstanding accounts on reports, including Outpatient Exception, Alpha Discharges, Alpha Inpatient, Inpatient Insurance Verification Reports and Scheduled Surgical Cases. Ensures compliance with department standards. Consults with team members and makes recommendations to address untimely processing of accounts and/or tasks. Identifies actions needed for performance improvement. Reports and identifies any trending or problems to Manager weekly with suggested recommendations to improve the processing of accounts. Assists with working all reports that ensure that verification, preregistration and precollect for all accounts that we clear for are completed within the standard turnaround time.


    • Minimal Qualifications
    Education

    • High School Diploma or GED required
    • Associate degree in healthcare preferred
    • Related certifications from AAHAM, HFMA, and related organizations preferred
    • One year of relevant education may be substituted for one year of required work experience.

    Experience

    • 1-2 years job related experience and knowledge of hospital or physician business office procedures required
    • Experience in pre-authorization and pre-certification, revenue cycle management, or insurance related fields required
    • 1-2 years successful supervisory experience in a hospital or physician office environment preferred
    • Knowledge of medical terminology, procedure and diagnosis codes required
    • One year of relevant professional-level work experience may be substituted for one year of required education.

    Licenses and Certifications

    • HFMA, NAHAM, or AAHAM revenue cycle certification, e.g. CHAA, CHAM, CRCS, CRCS or related field preferred

    Knowledge, Skills, and Abilities

    • Detailed working knowledge and proficiency in supervising payer authorization and pre-clearance processes with particular focus on understanding of payer requirements.
    • Ability to resolve complex payer issues to completion, training individuals in the authorization, pre-clearance, and denial processes.
    • Excellent leadership, communication, telephone etiquette, and interpersonal skills.
    • Able to deal effectively and professionally with a variety of different individuals.
    • Excellent organizational skills to manage multiple tasks in a timely manner.
    • Ability to perform in a high-pressure, fast-paced environment.
    • Proficient use of hospital registration and/or billing systems, and Microsoft applications, and other software applications.


    This position has a hiring range of $59,820 - $101,836

     


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