Description
Join our amazing team at The Steadman Clinic, and be an integral part of a cutting-edge organization that is amongst the best in the world at what they do. This is an excellent opportunity to take your health care career to the next level in a unique and highly valuable role, or kick it off with a world-class organization in an amazing facility. Vail, Colorado is one of our nation's iconic mountain destinations, and highly desirable spot to live if you love the outdoors. This position is eligible for our excellent benefit packages and perks (including a wellness benefit you can use for your ski pass!), and strong work-life harmony. This is an IN OFFICE role.
Manages all aspects of the organization’s insurance operations including the daily activities of Patient Access Medical Insurance and Prior Authorization departments to ensure high quality customer service and improve revenue cycle activities for prior authorizations, documentation, billing, and claims. Understands regulatory and third-party payer guidelines for admissions, discharges, ambulatory visits, diagnostic imaging, inpatient and outpatient services, billing, to ensure authorization functions and staff remain in regulatory compliance. Works collaboratively with TSC and OCP management team.
Classification: This is a full-time, year round, exempt position with benefits.
Location: Avon, CO.
Tentative start date: Summer 2024 - Applications for this position will be accepted until 30 days from the posting date. If the position is not filled during this time, the application window will be extended. Candidates who are selected to move through the interviewing process will be contacted directly.
Major Job Responsibilities/Essential Functions:
- Ensure that budget guidelines are met, and to provide appropriate resources based on the department volumes and activities
- Oversees training, education, and staff development
- Promotes cross training and develops staff to enhance job function and responsibilities so that maximum flexibility within Patient Access is achieved
- Coordinates and communicates process updates and flows with internal departments at TSC and external departments, to ensure that Prior Authorizations are in place by the patient's service date to increase patient satisfaction, reimbursement, and problem resolution
- Takes an active role in denials reduction efforts, timely filing expectations for registration and authorization claim error resolution and serves as a subject matter expert for Revenue Cycle operations for registration and authorizations
- Continuously streamlines processes/systems to achieve maximum effectiveness
- Ensures that all employees are properly oriented and trained in operations and equipment, and annual competencies and certifications, licensures and education requirements are correct
- Ensures the accuracy and completeness of patient information entered into the EMR system
- Enforces various organizational policies consistently
- Manages daily activities of the Insurance/Authorization departments to ensure quality and quantity of work is maintained, and information with ordering and performing departments regarding patient authorizations is properly communicated in a timely manner
- Operates cost-effective departments in by monitoring labor hours and supply expenses
- Ensures adequate staffing levels are maintained to provide timely patient service and submission of authorizations
- Performs department audits to identify authorization errors and provides continuous written and verbal feedback to staff and management regarding audit outcomes
- Assigns and delegates tasks as needed in the absence of employees, so workflow is maintained
- Performs high level of patient service from all areas of responsibility
- Assist staff with dealing with patient service and insurance service issues, utilizing Payer Contracting and Insurance Payer Representatives when needed
- Maintains active involvement with all regulatory compliance functions by maintain up to date working knowledge of latest healthcare trends in authorization, insurance verification and benefits, reimbursement, claims denials, and hospital/clinical management
- Identifies, plans and implements processes that align with state and government regulations as needed
- Monitor and collaborate on workflows and processes to ensure that operations – e.g. registration, authorization, financial counseling, pre-service estimations and collections, and all other Patient Access Functions are optimizing the best outcomes for patients and the organization
- Lead employees with accountability of expectations by mentoring, coaching, discipline, etc.
- Perform audits to identify authorization errors while providing feedback to employees
- Manages budget and productivity targets within the department
Requirements
- Bachelor’s degree in Accounting, Healthcare Administration or equivalent preferred
- 3-5 years’ experience in insurance authorizations required
- Orthopedic billing and coding experience preferred
- Experience using an EHR system required
- Medical coding certification preferred such as CCS
- Knowledge of third-party physician specialty billing, contractual and compliance regulations, along with a demonstrated understanding of automated processes and claims submission
- Considerable knowledge of medical office operations, professional fee billing, reimbursement and third-party payer regulation and medical terminology is required
- Strong communication skills and ability to successfully deliver as appropriate, crucial conversations
- Ability to understand insurance authorization process flow, identify root cause analysis for issues, develop applicable, actionable and timely performance improvement plans
- Strong problem-solving skills and ability to make timely decisions in a fast-paced environment
- Ability to work, plan, research and conduct projects with minimal supervision
- Proven ability to interface well with leadership and physicians to engender trust and confidence
Benefits:
- Health Insurance (medical, dental, vision)
- Company 401k Contribution
- Paid Time Off
- Sick Time
- FAMLI Leave
- Paid Holidays
- Life Insurance
- Short and Long Term Disability Insurance; AD&D; Hospital Indemnity
- Referral Program Incentive
- Parking Available
- Discretionary Bonus Program and Ski Pass Benefit
- And more!
We are an Equal Opportunity Employer. We are committed to equal treatment of all employees without regard to race, national origin, religion, gender, age, sexual orientation, veteran status, physical or mental disability or other basis protected by law.
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