Manager, Authorization Management

Manage and coordinate all daily functions in the Patient Access Centralized Authorization Management Department including management of a diverse group of staff roles. Responsibility for department processes to include: Insurance eligibility, benefits and coverage, certification requirement, Patient Pre-Registration for inpatient services, utilization review for all inpatient and observation patient stays. Ensures a quality service to patients, physicians' offices and ancillary departments across Norton Healthcare. Research and resolve conflicts. Track and escalate payer issues to provider representatives and managed care. Assist in resolving and/or escalating of collections/billing/revenue integrity questions, concerns or issues. Escalate registration related issues to the appropriate leadership of those facilities for corrections when necessary. Enters avoidable day codes that are associated with registration related delays affecting the department. Collaborate with others ensuring resolution of issues and promotion of interdepartmental collaboration. Elevate opportunities for improvement and action plans to meet objectives. Ensure all department processes are in line with timely patient flow and supports a positive customer experience.

Key Accountabilities:

• Ensures all communication with patients, physicians and physician office staff as well as all facility representatives are performed in a timely, courteous and professional manner ensuring processes support a positive customer experience.
• Ensures department staff are knowledgeable users of technology and follow all established policies and procedures while providing the highest level of customer service. Continually assess the insurance authorization process for opportunities to streamline and eliminate duplication of work. Collaborate with managers internally and externally to Norton Healthcare. Leads performance improvement projects. Educates staff on proper hospital and payor authorization requirements. Update and maintain organized databases regarding payor requirements. Holds team accountable to staying up to date and meeting said requirements. Work directly with managed care and provider representatives to address payor authorization concerns/issues. Identifies and provides feedback to patient access directors on coverage updates.
• Responsible for leading centralized utilization review department comprise of diverse roles in initiatives to drive performance metrics developed by system leadership and assist in the management of financial resources to meet and exceed the expected budget. Manages annual performance evaluations for direct reports and provides feedback to leaders and others as requested. Promotes employee engagement working collaboratively with leadership and team to develop action plans which ensure that workforce concerns are being addressed. Holds team accountable to department quality and productivity metrics. Ensures staffing levels are managed to meet the need of patient volumes and organization standards for customer service while meeting budget and productivity objectives and department goals which impact the revenue cycle metrics.

Required:

• Three years Utilization Review/Care Management experience
• Bachelor Degree

Desired:

• Three years management