Manager PAS PSO Prior Authorizations

1000 Wellstar Health System, Inc. • Atlanta, GA

1d

About The Position

Under the leadership of the PAS Director of PreService Operations, coordinates and controls the staff and activities to promote the highest level of effectiveness in meeting established goals and objectives. Responsible for performing a wide variety of clerical procedures that requires independent judgment, ingenuity, and initiative. Ensures adherence to policies and procedures, improvement in employee engagement, quality and excellence of work performed, world class customer service, and continual staff education. The key areas of responsibility include Prior Authorizations for scheduled services. The responsibilities are included within the PAS department's preservice functions which include scheduling, insurance verification, prior authorization and pre-registration In lieu of Director, the Manager will continually monitor Key Performance Indicators as established for PAS and ensure PAS PreService Operations is meeting or exceeding each goal. When goals are not met, the Manager is responsible for developing corrective action plans and communicating them to the PAS Director PreService Operations. The Manager is responsible for supporting the development of a compliance with the annual operating and capital plans. The Manager is responsible for maintaining positive working relationships with key PAS stakeholders. Demonstrates professionalism, effective communication skills and active listening skills.

Requirements

• Bachelor's Degree in business, healthcare or related field
• CHAA - Cert Healthcare Access Assoc or CHAM - Cert Healthcare Access Mgr or CHFP - Cert Healthcare Financial Prof or CPAR - Certified Patient Account Rep or CRCR - Certified Revenue Cycle Rep
• Strong interpersonal, analytical, problem solving and writing skills.
• Must be comfortable interacting with department Directors and Administrators and able to perform a wide variety of tasks that require independent judgement, ingenuity, and initiative.
• Proficient with MS office.
• Demonstrates professionalism, effective communication skills and active listening skills.

Responsibilities

• Leading, Planning, and Human Resources. Responsible for the effective leadership of Supervisors, Team Leads, and PAS staff. Assists with the daily planning, organizing, prioritizing and management of Patient Access Service operations. Demonstrates effective leadership skills, providing direction to the Supervisors in the performance of their supervisory functions. Collaborates with Administrators, Executive Directors, and Directors to design and implement services that facilitate the vision of WellStar and facility-specific objectives. Motivates employees to excel. Contributes to cohesive group relations, cooperation, and teamwork. Holds staff accountable for meeting Key Performance Indicators including Prior Authorization completion rates for scheduled services, productivity, quality of work performed by direct reports, and monitoring initial denial trends. Collaborates with PAS Revenue Cycle leadership to develop and implement goals, objectives and Action Plans for the department. Represents the department at various WHS PAS meetings and functions. Participates in special projects. Assumes accountability. Responsible for the ongoing management of daily operational functions of the assigned team(s) within the department. Completes and coordinates employee performance reviews and annual evaluations. Works closely with management team in the hiring, counseling, dismissals, promotions and transfer of employees. Mentors and coaches team to promote effective and productive leadership within the department and culture of accountability. Monitors absenteeism and ensure that counseling is consistently given for noncompliance with WellStar Health System policies and procedures. Maintains updated PAS personnel files
• Maintains orderly and clean work environment, commensurate with the public expectations of a healthcare organization. Assures PAS PreService Operations Prior Auth team is enforcing WellStar/department dress code. Assures PAS PreService Operations Prior Auth team has appropriate equipment and supplies to perform job duties. Available to assist staff needs 24/7. Preferred Leadership Qualities Drive: Capacity to channel energy to achieve personal and professional goals with a focus on continual innovation and improvement. Intellectual Acumen: Strong desire to continually search for new information and the ability to adapt to new situations. Desire for continuous learning and has the ability to think in a multi-faceted way to achieve results. Relationships: Ability to establish and develop relationships and understand the value of effective communication. Courage to seek and ask the right questions and to recognize and understand the importance of listening and building trust. Focus: Ability to work in a fast-paced environment that requires results. Ability to accept, adapt, and drive continuous improvement, change, and innovation.
• Communication, Collaboration, Partnership and Customer Service. Maintain courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, customers and the general public. Responsible for ensuring that high quality, customer-driven services are provided. Maintains ongoing communication with other departments, keeping the PAS PreService Operations Director aware of more complex problems and opportunities. Conducts regular meetings with staff. Ensures information is disseminated to staff. Reviews and analyzes departmental reports regarding productivity, quality and performance measures. Implements appropriate action to ensure data is within acceptable limits. Interacts with Directors and Managers from many departments regarding a myriad of issues. Resolves patient, physician, interdepartmental and other customer issues in a timely and appropriate manner. Demonstrates ability to tactfully handle difficult situations through an approach that reflects consistency and fairness. Monitors facility and area customer service scores, taking appropriate action to stay within acceptable limits. Maintains positive relationships with other department personnel. Pursues excellence in all areas related to customer service, including service recovery. Works collaboratively and as a team member with hospital leadership. Partners with Human Resources to achieve desired organizational culture, staffing and workforce metrics. Fosters positive working relationships between staff and physicians across the Health System. Fosters a culture that focuses on patient satisfaction, safety, customer service, staff participation, collaboration, motivation, and effective communication.
• Expected Performance, Behaviors and Results: The WellStar Experience (Must demonstrate a commitment to Service Excellence by): Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members. Valuing patients and family members as partners in their care. Having world-class processes in place. Delivering high-touch care that is reliable, responsive and coordinated. Focusing on constant innovation and creating improvements. Celebrating our diversity with sensitivity and understanding. Embracing the idea that we are all owners of our health system. Budget/Financial and Quality/Safety- Responsible for assisting in the development and monitoring of the PAS budgets and in the financial contribution of all supervised departments. Develops and monitors the departmental budget. Ensures monthly variance reports are accurate and thorough. Responsible for monitoring and maintaining Prior Auth completions prior to scheduled services. Collaborates effectively with other department Managers to maximize throughput to minimize wait times. Conducts studies to improve productivity, streamline operations and reduce error rates. Manages resources and supplies efficiently to administer cost effective services to the community. Resolves errors and applicable Claim, DNB and Patient WorkQueues. Monitors and ensures maintenance of accounts, DNB/Denials, claim, patient, and other related Workqueues that impact the Revenue Cycle. Coordinates monthly Denial resolution for assigned inventory. Ensures quality and drives resolution of initiatives which impact the overall health of the Revenue Cycle. Monitors processes to adhere to any regulatory requirements set by state, federal and/or governing bodies.
• Performance Improvement, Compliance/Regulatory, Trust/Engagement, Staff development, Results Oriented, - Supports and participates in department and facility performance improvement efforts. Ensures appropriate participation and management of area and department involvement in performance improvement projects. Analyzes results of PI projects and implements changes for improvement. Collaborates with direct reports to implement and complete appropriate PI projects in support of WHS vision and mission. Facilitates intra-department coordination, standardization and outcome targets for key access processes including: scheduling, data collection, insurance verification, authorization, registration, admitting and bed control. Coordinates with outpatient clinics and ancillary services, physician practices, referral hospitals, community and public agencies, and WellStar Health Systems bed control staff to streamline patient access procedures. Assists with the development and maintenance of the department Policy & Procedure. Develops and monitors appropriate policies to ensure compliance to continually improve PAS services Respects and maintains the privacy of patients personal/protected health information. Adheres to and educates staff about the importance of HIPAA and patients personal health information. Assures that all PAS personnel are trained in corporate compliance, Fraud and Abuse, including maintaining the integrity of billing and coding related activities Builds a culture of trust and engagement as reflected in the Great Place to Work Trust Index Survey at a direct report, workgroup and hospital/entity level. Holds leaders accountable for behaviors that create trust and engagement. Performs all duties and responsibilities of this position in a manner that reflects the values of WellStar. Maintains and strengthens relationships with physicians and assures their involvement in developing systems to assure the growth of the service and the cost effective delivery of quality patient care in a manner that fosters patient and employee satisfaction. Provides assistance with staff training, departmental projects and presentations, as needed. Maintains a working knowledge of all Patient Access Service functions, employee positions and job requirements. Attends outside workshops and classes to ensure a competency level that is beneficial to the department, as well as to meet minimum requirements in technology advances/applications. Sets challenging and productive goals for team. Holds team accountable for actions while providing leadership and motivation. Provides resources and support, Uses checkpoints and data to track progress, setting up system and processes to measure results. Seeks opportunities to improve workflow and efficiency by embracing automation where possible. Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1-10 employees