UCSD Layoff from Career Appointment: Apply by 05/10/19 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 05/21/19. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Involves the management and administration of patient pre-registration and registration, pre-admissions and admissions, transfers, and insurance eligibility and authorization. Functions are provided in concert with clinical and business departments across the organization, to ensure efficient patient flow and to maximize revenue collection.
Works closely with patient financial services and case management department to maintain payer requirements and analyze denials. Participates in strategic planning and budget processes. Provides direction, sets priorities and analyzes workflow for inpatient authorization team, according to established policies and management guidance. Recommends, develops and implements new and revised procedures as needed.
Key Responsibilities:Provides oversight to ensure contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests are completed. Ensures urgent authorization requests are handled in a timely and compliant manner. Ensure compliance with government and commercial billing processes.Works in conjunction with other UM staff to improve service quality initiatives, develop audit tools, and meet regulatory and other quality standards.
Manage Patient Access related DNB, claim edits and stop bills. Track, trend, and report on Patient Access related CFB. Recommends, reviews, and oversees the implementation of best practice methods and policies which improve both patient quality of care and the financial outcomes for the medical center. Instills strong management practices to create a culture of teamwork, collaboration, and timely achievement of objectives and goals. Responsible for employee performance reviews, recruitment, retention, terminations, and staff development and training programs.
A Bachelor's Degree in business, healthcare administration or related area; and/or equivalent experience/training.
Five (5+) or more years of relevant experience - Revenue Cycle Management, Patient Access, Authorization, Case Management/Utilization Review.
Experience and proven success in supervisory, organizational, and customer service skills to effectively supervise and prioritize the activities of subordinate staff, and to manage the complex workflow and multiple priorities of admissions and registration.
Proficiency with EPIC applications.
Knowledge of Inpatient Authorization processes.
Government (Medi-Cal, Medicare, CCS) Inpatient billing processes.
Background in Utilization Review.
Denials/CFB management experience.
Must be able to work various hours and locations based on business needs.
Employment is subject to a criminal background check and pre-employment physical.
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