Manager, Enterprise Authorization Services

🕒 Outubro 5

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 18%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 38 dias.
• As vagas desta empresa costumam ser preenchidas em 22 dias.
• Sem salário divulgado.

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WVU Medicine

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance

WVU Medicine é um sistema de saúde abrangente afiliado à West Virginia University, fornecendo serviços médicos através de uma rede de hospitais em todo o estado da Virgínia Ocidental. O sistema inclui instalações notáveis como o J. W. Ruby Memorial Hospital, WVU Medicine Children's, e vários outros centros médicos regionais. WVU Medicine oferece uma ampla gama de serviços de saúde, incluindo tratamentos médicos especializados e avançados, como cirurgia cardíaca robótica. Também está envolvido na educação médica, pesquisa e iniciativas de saúde comunitária, enfatizando a missão de fornecer cuidados de alta qualidade às comunidades que serve.

Descrição

• Coordinate and control activities related to insurance prior authorization • Research and analyze denied services to create and implement workflows that minimize payment denials • Manage, lead, train, develop, direct, and evaluate a team of authorization specialists • Communicate revenue risks to Departmental Directors and Clinic Administrators • Review authorization productivity and timeliness; develop and implement action plans • Monitor staffing levels and reassign work according to organizational priorities • Audit authorization staff work for quality, productivity, and timely authorization and treatment-plan submission • Monitor insurance authorization and reimbursement data trends and report findings to the Director • Identify, implement, monitor, and revise process-improvement initiatives • Propose technology improvements to enhance performance and productivity • Maintain knowledge of payor authorization requirements and state/federal coverage regulations • Oversee pre-certification workflows for assigned services • Analyze denial-management metrics and lead denial-reduction initiatives • Collaborate with hospital billing, professional billing, Outpatient Registration, and Revenue Cycle teams to resolve complex denials and authorization barriers • Manage assigned hospital functions, facilitate timely review, and support front-end peer-to-peer appeals • Represent pre-authorization services in relevant internal and external meetings • Analyze new services for pre-authorization and denial-reduction guidance

🎯 Requisitos

• High School Diploma or Equivalent • Five (5) years’ experience healthcare accounts receivables management, billing and collections • Two (2) years of supervisory experience • Knowledge of computers and use/manipulation/application of data for administrative functions • Knowledge of Medicare, Medicaid and other regulatory requirements • Knowledge of UB-04, itemized bills, insurance plans, grievance procedures and utilization management processes • Knowledge of managed care, inpatient and outpatient care, utilization management, and InterQual criteria • Knowledge of patient billing operations • Knowledge of medical terminology and ability to interpret medical-record information • Knowledge of CPT, ICD9/10, and DRGs • Previous experience in an administrative or supervisory role • Effective organizational skills, attention to detail, initiative, and follow-through • Preferred: Bachelor’s degree in Finance, Business Administration or related field • Preferred: Certified Healthcare Financial Professional (CHFP) with HFMA • Preferred: Knowledge of EPIC system

🏖️ Benefícios

• Full-time schedule of 40 hours per week • Exempt status

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