Some call it a career. For us it's a calling.
As the leading respiratory hospital in the nation, National Jewish Health is pioneering a new era of preventive and personalized medicine. By combining our efforts in comprehensive care, academic education and ground-breaking research, we're able to develop treatments that help our patients live more productive lives. We breathe science so our patients can breathe life. If you believe in working for an organization where Breathing Science is Life, we invite you to join our team!
Manages the daily operations for the Insurance Verification (IV) and Utilization Management (UM) team, including staffing, workflow processes, reporting, complaint resolution, employee leadership and on-going staff education. Accountable for creating a culture of compliance, ethics and integrity. Maintains and shares with team insurance and payer standards and changes.
- Determines staff qualifications and competency: recruits, selects, hires, trains, orients, mentors and rewards.
- Supervises and develops an effective staff: providing effective communication, leadership, guidance and resources. Directs in-service and continuing education activities for staff. Monitors staff safety compliance and use of Personal Protective Equipment (PPE), as needed.
- Evaluates staff performance regularly and determines merit increases, promotions and disciplinary actions.
- Responsible for verifying that insurance, referrals, pre-notification, precertification, authorization, medical terminology and coding practices are followed for all ancillary procedures.
- Monitor local patient UM workflow to assure timely authorizations for all scheduled procedures. Continually assess UM workflow for improvement opportunities.
- Accountable for IV/UM compliance to regulatory and insurance standards.
- Measures turnaround time (arrival to completion) of IV requests. Establishes and maintains turnaround time expectations for IV to support NJH goals.
- Manages Program patient utilization management team. Monitors workflow to assure timely authorizations for all Program Services scheduled. Maintains strong communication with Manager, Program Patient Services.
- Accountable for the coordination of the administrative aspects of Infusion Centers including insurance verification, third party authorization, pharmacy coordination, Drug Map Program and the completion of the standard schedule in an appropriate manner for Oncology and Infusion patients through oversight of Infusion Coordinator.
- Provides coaching, leadership and direction to a team who are responsible for providing IV and UM services. Establishes and maintains on-going insurance education for IV and UM staff.
- Completes quality assurance review of staff work. Meets with staff monthly to review performance related to quality and quantity.
- Generates and presents key performance indicator reports to Director on a weekly and monthly basis.
- Reviews claim denials monthly for verification and authorization errors. Report monthly findings to Director.
- Serves as a key member of patient care team and proposes procedural and system changes when appropriate.
- Works closely with other Administrative Services leaders and Patient Financial Services.
- Develops written policy and procedural manual for IV/UM team. Responsible for ensuring IV/UM team adheres to institutional and Departmental polies.
Knowledge and Skills:
Incumbent must be proficient in Microsoft Office Suite applications, including Outlook, Excel, and Word, and other business applications. Effective written and oral communications skills and effective organization abilities are required. Knowledge of medical terminology and procedures is required. Incumbent must have the ability to handle multiple projects at once. Capacity to establish and maintain constructive business relationships with internal and external customers while maintaining integrity and confidentiality. Incumbent must be a positive, professional team player, able to manage project time constraints and work with little supervision.
Bachelor's degree in related field is required, in healthcare or business administration preferred.
A minimum of five (5) years of recent and related experience in health care with insurance verification, precertification or utilization management required. A minimum of three (3) years recent management or supervisory experience required.
Manages 9-11 employees