Emory

  • Director Pre-Certification, Revenue Management

    Division
    The Emory Clinic
    Campus Location
    Decatur, GA, 30030
    Campus Location
    US-GA-Decatur
    Department
    TEC PFS AR Management
    Job Type
    Regular Full-Time
    Job Number
    17433
    Job Category
    Revenue Cycle & Managed Care
    Schedule
    8a-5p
    Standard Hours
    40 Hours
  • Description

    Oversees the key functions within the revenue cycle for The Emory Clinic (TEC) that pertain to charge capture, coding and edit management; with resources that include both clinical departments and Patient Financial Services (PFS) to coordinate best in class performance in specific categories of revenue cycle. Responsible for meeting and exceeding specific metrics related to the above functions. Will determine and establish the revenue cycle integration model and implementation for consolidating these functions across the clinical departments in efforts to build centralized support services. Responsible for organizing and overseeing the work of staff who serve in reimbursement functions to include positions such as but not limited to the Reimbursement Manager across TEC. Serve as Chairperson of the Reimbursement Manager forum and Business Leadership Group / Manager Training forums to organize and develop agenda and programs to address revenue management issues. Consolidate and revise all Revenue systems training programs involving the following elements and progress toward Revenue Cycle "Certification" for TEC key staff.

    MINIMUM QUALIFICATIONS: Bachelor's degree required in related field or healthcare preferred. Master's degree preferred. At least 7 years experience with revenue cycle functions, preferably in both the shared service and clinical department environments. Demonstrated understanding in how to manage resources across an organization to make an enterprise-wide impact. Experience with ambulatory care environments and ability to translate and embed standard operating procedures and process into the clinical environment where appropriate.

    PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

    ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

    Additional Details

    - Oversees Emory Healthcare's efforts around precertification of patients insurance within the Health System. Works closely with System Finance to maximize our efforts around precertification and works with both employed and non-employed physicians to enhance our precertification process. -

     

    JOB DESCRIPTION: Oversees the key functions within the revenue cycle that pertain to pre-certification activities for Emory Healthcare. Will develop and execute organizational structure to centralize pre-certification functions for hospitals and physicians for Emory Healthcare, including development of best in class Section/POD structure. Responsible for developing business processes and work queues that allow for improved patient and physician experiences related to pre-certification activities. Will develop productivity, quality and management reports related to pre-certification functions. Responsible for meeting or exceeding key metrics related to pre-certification functions. Oversees the daily activities of the pre-certification management team and staff in support of pre-certification revenue cycle function. Provides feedback and guidance to the physicians/Sections on trends/issues impacting ability to obtain pre-certification. Reviews reports, statistical summaries, and quality audits using current available technology to support appropriate organizational decisions. Provides guidance and expertise to Managers, Supervisors, staff and Section Administrators as needed. Works closely with multiple hospital and clinic departments, as well as Emory Healthcare leadership. Focuses closely on payer denial avoidance.

     

    MINIMUM QUALIFICATIONS: Bachelor's degree required in related field. Master's degree preferred. At least seven years experience in Pre-certification or Utilization, preferably in an academic setting. A minimum of three years in staff management and/or director responsibilities. Demonstrated understanding in how to manage resources across an organization to make an enterprise-wide impact Experience with denials management and clinical appeals would be highly desired. - 77385BR

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