Director, Centralized Precertification

Emory•Atlanta, GA

10d

About The Position

Overview: The Director of Pre-Certification will oversee the pre-certification process within Emory Healthcare, ensuring that all medical services, procedures, and treatments meet regulatory and insurance requirements before they are delivered. This leadership role requires a strategic thinker with a deep understanding of healthcare regulations, insurance practices, and operational efficiencies. The Director will lead a team of pre-certification specialists, collaborate with clinical staff, and engage with insurance providers to enhance patient care and streamline operational processes.

Requirements

Bachelors degree in Healthcare Administration, Nursing, or a related field; Masters degree preferred.
Minimum of 10 years of experience in healthcare administration or a related field, with at least 5 years in a leadership role focused on pre-certification or utilization management.
Extensive knowledge of insurance verification and healthcare regulations.
Strong analytical and problem-solving abilities.
Excellent communication and interpersonal skills.
Proven leadership and team management capabilities.
Proficiency in healthcare management software and data analysis tools.

Responsibilities

Leadership and Management: Lead, mentor, and develop a high-performing team of pre-certification specialists. Establish performance metrics and ensure the team meets operational goals and compliance standards.
Process Optimization: Review and refine pre-certification processes to improve efficiency and accuracy. Implement best practices for tracking and documenting pre-certification requests.
Collaboration and Communication: Work closely with clinical teams to understand service needs and facilitate timely pre-certifications. Act as a liaison between the organization and insurance providers to resolve issues and enhance communication.
Compliance and Regulatory Oversight: Ensure compliance with all federal, state, and local regulations regarding pre-certification. Stay updated on changes in healthcare laws and insurance policies that may impact pre-certification processes.
Data Analysis and Reporting: Analyze pre-certification data to identify trends, challenges, and opportunities for improvement. Prepare and present reports to senior management on pre-certification metrics and departmental performance.
Training and Development: Develop and deliver training programs for staff to enhance their understanding of pre-certification processes and insurance requirements. Foster a culture of continuous improvement and professional growth within the team.