"Revenue Cycle Manager (Authorization)"

Position Summary

The Revenue Cycle Authorization Manager has direct oversight of a central unit that is responsible for securing insurance & benefit coverage as well as obtaining authorization for scheduled and unscheduled services as required by payer policy. The Manager is responsible for unit performance, work quality, efficiency, and compliance with policies and regulations.

Responsibilities

Operations

• Direct day-to-day management of the authorization unit. Monitor and manage operational workflows, work queues, and programs on a regular basis for efficient use of resources. Assesses the need for new tasks or functions. Ensure that the priority matrix for work is adhered to. Monitor work queue inventory to ensure that accounts are worked timely manner. Advise Directors of potential backlog and advise remediation.
• Ensure policies and procedures are kept up to date and are communicated, ensuring that information is understood and adhered to by supervisors and staff.
• Intervene to manage special projects and/or higher complexity issues escalated by Authorization Specialists for resolution.
• Implement approved quality and audit control measures to achieve compliance and optimum efficiency.
• Serve as the subject matter expert responsible for troubleshooting, analyzing, and performing resolution management for authorizations.
• Evaluate work queues to ensure WQs are capturing the appropriate activities and analyzing inflow for issues & trends. Analyzes patient WQs to find trend issues and works with appropriate management and departments, such as IT, to bring issues to resolution.
• Review, understand, and communicate payer industry standards, policies, and other changes to supervisors, staff, and departments. Stays apprised of payer process changes. Stays apprised of batch and electronic insurance eligibility and other insurance coverage tools for improved automation.
• Conduct analysis, provide feedback, and prepare reports on insurance verification activities/operation (e.g., operational efficiencies) to Directors.
• Responsible for maintaining and developing workflows and assisting in backlog reduction.
• Review denial reports for trends and research denials related to authorizations. Identifies root causes and prepares issues for escalation.

Strategic

• Work collaboratively with clinical departments to establish effective communications to further the efficiency of the revenue cycle process.
• Serve as an individual or team contributor towards achieving established organizational goals across all Revenue Cycle units.
• Collect and evaluate data to identify trends and gaps across Revenue Cycle processes. Uses analysis to make recommendations for improvements and optimization. Participates in improvement/optimization initiatives.
• Develop and maintain a good working relationship with all practice managers, departmental management, and the NYP Financial Clearance Center department. Promotes a customer service orientation in interactions with patients, physicians, department staff, and external organizations through personal example.

People

• Direct oversight of assigned management and staff, including but not limited to unit supervisor(s) and specialists, inclusive of recruiting and human resource management. Manages and mentors supervisors to onboard and train authorization staff. Provides guidance and direction to supervisors on managing staff.
• Promote staff professionalism and performance with training and feedback.
• Evaluate staff performance and take corrective action per departmental HR guidelines. Review staff productivity and quality measures. Administer improvement plans as required.

Compliance and Other

• As a member of the management team, performs other tasks and assumes additional management or supervisory responsibilities within the Revenue Cycle Department as assigned.
• Represent the FPO on committees, task forces, and work groups as assigned.
• Conform to all applicable HIPAA, Billing Compliance, and safety policies and guidelines.
• Other duties as assigned.

Minimum Qualifications

• Requires a bachelor’s degree or equivalent in education and experience.
• Minimum of 4 years’ related experience in a physician billing or third-party payor environment.
• An equivalent combination of education and experience may be considered.
• Demonstrated intermediate skills in problem assessment, resolution, and collaborative problem solving in complex and interdisciplinary settings, including strong proficiency in healthcare and payer guidelines as they pertain to authorizations.
• Ability to work collaboratively with a culturally diverse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
• Ability to work independently and follow through, and handle multiple tasks simultaneously.
• Excellent verbal and written communication skills.
• Intermediate to advanced level proficiency in Microsoft Office (Word & Excel) or similar software is required, and an ability and willingness to learn new systems and programs.
• Must be a motivated individual with a positive and exceptional work ethic.
• Demonstrated intermediate proficiency in health insurance authorization and referral process as it pertains to insurance and managed care reimbursement concepts and overall operational impact.
• Must successfully complete systems training requirements.

Preferred Qualifications

• At least 2 years of direct supervisory experience is preferred.
• Knowledge of Epic and GE/IDX billing systems is preferred.
• Managed care industry experience is preferred.

Other Requirements