Prior Authorization & Referral Manager

Job Summary Primary responsibilities are to plan, organize and supervise functions of the business office for Roosevelt General Hospital District.
Establishes policies and goals for supervised departments.
Supervises assigned department operations to ensure quality patient needs are met.
Essential Functions: Ensures the highest level of customer service from the business office to patients and patient’s family.
Ensures that appropriate documentation is obtained for prior authorizations, referrals, and surgical scheduling.
Supervises activities of referral/prior authorization and surgical scheduling.
Manages personnel including hiring, orientation, assigning, counseling, discipline, training, education, evaluation and progressive disciplinary action according to current policy.
Develops and implements performance and behavior standards.
Responsible for managing the MEDITECH system to include the Insurance Verification Desktop, Referral Management Dashboard, and other applicable modules to referrals and prior authorizations.
Responsible for submitting tickets to MEDITECH Circle to report issues with the system.
Responsible for tracking and reporting productivity of each referral specialist to ensure the workload is being distributed fairly and the work is being completed in a timely manner.
Ensures the delivery of quality Referral and Prior Authorization services to patients in a timely manner.
Ensures HIPAA is being upheld in areas of Business Offices.
Ensures appropriate surgical scheduling protocols are being followed.
Ensures the optimal number of patients are scheduled for our OR in a manner that is conducive to the operating room and surgeon.
Ensures referrals and prior authorizations are addressed within 5 business days or less.
Ensures inpatient and observation services are prior authorized within 24 hours of admission Monday-Friday.
Ensures all outpatient procedures performed at RGH are prior authorized.
Ensures all calls coming into RGH Referral Department are answered in a timely manner.
Ensures calls are correctly addressed.
Ensures departmental compliance with established policies, State licensure and other regulatory standards, including safety, environmental and legal requirements, and policies and procedures.
Establishes and manages quality improvement measures and action plans.
Develops and maintains relationships with all Providers.
Develops and implements departmental policies, procedures, workflows, goals and objectives.
Ensures departmental accountability and customer satisfaction.
Communicates pertinent information to employees on a timely basis.
Coordinates with medical, nursing, and accounting staff to ensure appropriate placement of patients and compliance with third party payers and other regulations.
Resolve both internal and external complaints relating to the Business Office.
Supervise the work of office, administrative, or customer service employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors, or problems.
Provide employees with guidance in handling difficult or complex problems and in resolving escalated complaints or disputes.
Implement organizational and departmental policies, procedures, and service standards in conjunction with management.
Discuss job performance problems with employees to identify causes and issues and to work on resolving problems.
Train and instruct employees in job duties and company policies or arrange for training to be provided.
Interpret and communicate work procedures and company policies to staff.
Establishes and manages quality improvement measures and action plans.
Reviews employee satisfaction survey results with staff and develops and implements action plans to improve the work environment.
Reviews customer satisfaction survey results and develops and implements action plans to improve satisfaction scores.
Acts as a role model for employees providing exceptional leadership.
Non-Essential Functions Perform other duties as assigned Professional Requirements Maintain patient confidentiality at all times Maintain professional uniformed attire provided by RGH Complete continued education/training requirements Report to work on time and as scheduled Wear identification while on duty Maintain regulatory requirements, including all state, federal and local regulations Represent the organization in a positive and professional manner at all times Comply with all organizational policies and standards regarding ethical business practices Communicate the mission, ethics and goals of the organization Participate in performance improvement and continuous quality improvement activities Must have full-time availability and be able to work a flexible schedule, including nights, weekends and holidays.
Attend monthly staff meetings Qualifications Associates degree in Business Administration, Health Administration, or related field preferred 1 to 3 years of healthcare business functions experience in Referrals/Prior Authorizations 2 or more years of management experience No active formal counseling Medical terminology knowledge preferred Intermediate computer knowledge Typing speed: minimum 40 wpm, computer knowledge Spanish speaking is preferred Experience in interviewing and selection of staff is preferred Knowledge of CPT / ICD 10- coding Knowledge, Skills, and Abilities Must have Microsoft Excel, Microsoft Word, and Microsoft PowerPoint skills Must have an enthusiastic and positive attitude Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks Ability to initiate communication with patients, their families and hospital visitors Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families Must have a professional demeanor and excellent public relations skills Willingness to develop or improve public speaking skills Knowledge of medical insurances (Medicare, HMO’s, PPO’s, commercial), EMTALA regulations, hospital billing and collection process Must have excellent written skills with knowledge of medical terminology Ability to motivate people Must be dependable and on time Possess good 'people skills' for building relationships with colleagues at all levels Ability to plan and prioritize your own work and other people's Physical Requirements and Environmental Conditions Work is performed during regular work hours, but may include after hours to meet deadlines Work in varying degrees of temperature (heated or air conditioned) Work under extreme pressures Position requires sitting for approximately 4-6 hours per day and walking for 2 hours per day Position requires light to moderate work with 50 pounds maximum weight to lift and carry Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing