Department: UNMHS Appointment Center

FTE: 1.00
Full Time
Shift: Days

Position Summary:
Supervise Patient Services Representatives, Patient Care Coordinators, and other prior authorization referral scheduling staff. Ensure referrals and prior authorizations are obtained for all services of an elective or non-urgent nature. Ensure that appropriate and necessary notifications are made to insurance providers. Develop, implement, and direct the provision of appointments, referrals and authorizations. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.

Detailed responsibilities:
* APPOINTMENTS - Assist staff with scheduling and coordinating ancillary service and clinic appointments
* ASSIGNMENT - Oversee and assign case loads and staff hours to best suit Hospitals needs
* CONTINUITY OF CARE - Collaborate with the health care team to ensure continuity of patient care throughout all health care settings; promote effective communication among health care team members including the patient, family, and significant others
* COVERAGE - Organize case coverage during absence of staff
* CUSTOMER SERVICE - Conduct appropriate customer relations activities
* DOCUMENTATION - Provide routine verbal and written documentation for the initial assessment and progress of the patient to other members of the health care team in a timely manner
* EDUCATION - Develop educational mechanisms required to review basic staff skills and integrate new practices
* LIAISON - Act as liaison between staff, UNMH Business/Billing Department, Managed Care Office, Admitting and outside agencies
* OPERATIONS - Ensure departmental programs run smoothly and efficiently; oversee operations, schedule staff, and expedite problem resolution
* POLICY & PROCEDURE - Develop and maintain policies and procedures for referral, prior authorization management and centralized scheduling
* PROBLEM SOLVING - Troubleshoot and resolve referral and prior authorization problems with third party agencies
* PROCESS IMPROVEMENT - Monitor staff functions, identify opportunities for improvement, and take necessary steps to achieve the identified opportunity
* QUALITY - Monitor 96/72/48 hour 10-5day process and number of cancelled patients due to prior authorization or referral
* REIMBURSEMENT - Ensure optimal reimbursement from governmental third party payers, obtaining proper authorization
* REPORTS - Create monthly reports on UPA/UH denial activity by department
* DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
* RELATED WORK - Perform related duties and responsibilities as required
* ADMINISTRATION - Perform various administrative functions such as monitoring expenditures and preparing reports and correspondence; may participate in a variety of research projects to develop service plans; may propose changes to program policies and procedures
* SUPERVISION - Develop efficient organizational structure. Supervise employees and select, terminate, train, educate, correct deficiencies, perform appraisals, issue discipline, counsel, schedule work assignments; encourage staff teamwork and growth initiatives

Education:
Essential:
* High School or GED Equivalent
Nonessential:
* Bachelor's Degree
Education specialization:
Nonessential:
* Related Discipline

Experience:
Essential:
3 years directly related experience

Nonessential:
No preferred experience

Credentials:
Essential:
* Not Applicable/Not Required

Physical Conditions:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working conditions:
Essential:
* No or min hazard, physical risk, office environment
* May be required to travel to various work sites
* May perform subordinate tasks in high census/vol
* May be required or is required to perform on-call duties
* May work rotating shifts, holidays and weekends