JOB SUMMARY
Supervise Patient Services Representatives, Patient Care Coordinators, and other prior authorization referral scheduling staff. Ensure referrals and prior authorizations are obtained for all services of an elective or non-urgent nature. Ensure that appropriate and necessary notifications are made to insurance providers. Develop, implement, and direct the provision of appointments, referrals and authorizations. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.

ESSENTIAL FUNCTIONS - Essential and other responsibilities and duties may include but are not limited to the following:

APPOINTMENTS - Assist staff with scheduling and coordinating ancillary service and clinic appointments

ASSIGNMENTS - Oversee and assign case loads and staff hours to best suit Hospitals needs
CONTINUITY OF CARE - Collaborate with the health care team to ensure continuity of patient care throughout all health care settings; promote effective communication among health care team members including the patient, family, and significant others
COVERAGE - Organize case coverage during absence of staff

CUSTOMER SERVICE - Conduct appropriate customer relations activities

DOCUMENTATION - Provide routine verbal and written documentation for the initial assessment and progress of the patient to other members of the health care team in a timely manner

EDUCATION - Develop educational mechanisms required to review basic staff skills and integrate new practices

LIAISON - Act as liaison between staff, UNMH Business/Billing Department, Managed Care Office, Admitting and outside agencies

OPERATIONS - Ensure tdepartmental programs run smoothly and efficiently; oversee operations, schedule staff, and expedite problem resolution

POLICIES AND PROCEDURES - Develop and maintain policies and procedures for referral, prior authorization management and centralized scheduling

PROBLEM SOLVING - Troubleshoot and resolve referral and prior authorization problems with third party agencies

PROCESS IMPROVEMENT - Monitor staff functions, identify opportunities for improvement, and take necessary steps to achieve the identified opportunity

QUALITY - Monitor 96/72/48 hour 10-5day process and number of cancelled patients due to prior authorization or referral

REIMBURSEMENT - Ensure optimal reimbursement from governmental third party payers, obtaining proper authorization

REPORTS - Create monthly reports on UPA/UH denial activity by department

DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops

RELATED WORK - Perform related duties and responsibilities as required ADMINISTRATION - Perform various administrative functions such as monitoring expenditures and preparing reports and correspondence; may participate in a variety of research projects to develop service plans; may propose changes to program policies and procedures

SUPERVISION - Develop efficient organizational structure. Supervise employees and select, terminate, train, educate, correct deficiencies, perform appraisals, issue discipline, counsel, schedule work assignments; encourage staff teamwork and growth initiatives

MINIMUM QUALIFICATIONS

EDUCATION: High School Diploma or GED equivalent

EXPERIENCE: 3 years directly related experience

TESTING REQUIREMENTS: Tuberculosis testing is completed upon hire and additionally as required

PREFERRED QUALIFICATIONS

PREFERRED EDUCATION: Bachelor's Degree in related discipline

WORKING CONDITIONS

ENVIRONMENTAL CONDITIONS: No or min hazard, physical risk, office environment May be required or is required to perform on-call duties May be required to travel to various work sites May be required to work rotating shifts, holidays and weekends May be required to perform subordinate tasks in high census/vol

PHYSICAL CONDITIONS: Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Behaviors of Excellence - We Make it Better

We Care

-We treat everyone with courtesy and respect.
-We take time to listen.
-We make people feel welcome with a greeting and smile.
-We anticipate the needs of others.
-We value the patient’s perspective.

We do good work

-We keep our skills and knowledge up to date.
-We learn from our mistakes.
-We are thorough, accurate, and timely in our documentation.
-We are open to change and improved processes.-We care about the details.

We need each other

-We stay positive.
-We don’t gossip.
-We value our diversity.
-We help and encourage each other.
-We collaborate.

We share

-We thank each other often and share credit.
-We use appropriate language in speech and emails.
-We explain what we are doing, encourage patients, and provide updates.
-We share ideas and information, and we welcome feedback.
-We respond promptly to emails, pages, and calls.

We look after things

-We are good stewards of our resources, equipment, and supplies.
-We are dependable, reliable, and on time.
-We make efficient use of our time.
-We take the initiative and follow through.
-We do the right thing, even when no one is watching.

We keep it safe

-We wear our badges.
-We adhere to handwashing guidelines.
-We report any unsafe conditions that we see.
-We protect the privacy of our patients.
-We follow all safety protocols and respect the chain of command.

We show our pride by how we look

- We dress professionally and comply with the dress code.
-We maintain tidy work areas.
-We help keep our campus clean.
-We put things where they belong.
-We protect our institution’s reputation