Hybrid Financial Clearance Manager bei Genesis HealthCare System

GENESIS HEALTHCARE SYSTEM
 

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Position Details:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Financial Clearance

Overview of Position:

The Financial Clearance Manager is responsible for overseeing the financial clearance process, verifying insurance coverage, and securing prior authorizations. This role ensures compliance with insurance requirements, optimizes workflow efficiency, and supports healthcare providers in securing timely approvals; including but not limited to any scheduled service within the organization such as diagnostic testing, medical procedures, treatments, and medications. This position must maintain an awareness of payer guidelines and updates and proactively educate all stakeholders on changes to secure a standard authorization process. This role should leverage technology to achieve optimal efficiency, reduce preventable denials, and maximize patient access opportunities. This role plays a critical part in implementation of best practices to achieve the best outcomes with attention to quality, efficiency, and cost, while also enhancing the patient financial experience.

ESSENTIAL DUTIES
Process
1.    Oversee the submission, tracking, and resolution of prior authorization requests. This position works closely with all organizational departments and vendors to secure authorizations for all services scheduled within the system; this includes both employed and non-employed referring providers.
2.    Responsible for developing and maintaining infrastructure necessary to facilitate information collection and submission in order to obtain a timely prior authorization when required 
3.    Maintains fields within the billing system to assure compliance to billing and regulatory requirements, specifically related to authorization approval information. 
4.    Collaborates with clinical teams as necessary to obtain key information needed to obtain prior authorization with a special focus on creating standards and criteria within the medical record system referral form. 
5.    Handles patient complaints as needed with superb customer service. 
6.    Maintains up-to-date knowledge of third-party payer policies, regulations, and payer requirements. Ensures adherence to payer policies, healthcare regulations, and organizational Standard Operating procedures and programs; this includes collaborating with Payer Relations team to remain informed and compliant with evolving payer policies and federal guidelines. 
7.    Collaborates and serves as a liaison to Utilization Management Review department to assist with securing prior authorizations and maintaining knowledge of third-party payer requirements. 
8.    Identifies potential authorization or coverage issues to minimize claim denials, taking immediate action through education of staff or escalation of issues to payer relations team. 
9.    Proficient working with payer portals, EHR systems, and automated authorization tools, guiding direct reports with changes. 
10.    Collaborates closely with scheduling and registration departments on workflows, insurance verification processes, and communication of key elements necessary to secure a prior authorization timely; this includes various referral reporting  

Leadership
11.    Supervises and trains all staff responsible for checking and securing prior authorization, and quality and assurance of financial clearance processes.
12.    Responsible for leading the team and partnering with internal and external stakeholders in streamlining prior authorization workflows and reporting structures
13.    Develops a team structure that optimizes workflow and enables high collaboration with with revenue cycle operations to enable maximization of payer yield opportunities 
14.    Routinely reviews accuracy and quality metrics and works with team members to provide comprehensive training programs, refresher sessions, and robust digital reference guides embedded in the system 
15.    Holds team members accountable to meeting metrics that enable optimal payer yield performances, creating action plans when necessary to meet targets 
16.    Seeks opportunities to acquire more skills and abilities in support of professional and personal goals. Demonstrates a willingness to accept new roles and responsibilities to support the achievement of organizational goals.

Innovation 
17.    Analyzes data to determine areas of referral leakage and partners with divisional and operational leadership to support action plans for patient access, market share capture, etc. 
18.    Performs root cause analyses with denial trends to implement preventative strategies with appropriate service line leaders, and external stakeholders. 
19.    Monitors authorization trends, identify bottlenecks, and recommend process improvements.
20.    Analyzes financial clearance workflows and implements strategies to enhance efficiency, and reduce authorization delays, including third-party payer eligibility and coverage. 
21.    Analyzes workflow delays and seeks to develop rules in the medical record system to assist staff in collecting information to meet criteria and successfully obtain prior authorization in the quickest fashion without upfront or backend rejections and delayed payment or denial of payment 
22.    Leverages technology to optimize workflows and reduce preventable denials including but not limited to electronic medical record tools, Artificial Intelligence, and third-party vendors. 
23.    Plays an active role in identifying key elements necessary to obtain a timely authorization and explores opportunities to engage the third-party payer in the pre authorization process through automation, established platforms, and industry forums.

QUALIFICATIONS 
1.    Bachelor’s degree in a related field or, in lieu of a degree, incumbent will need at least three years of supervisory and field-related experience and must obtain a certification of achievement within the first 18 months of employment.  
2.    Minimum of three (3) years in prior authorization, insurance verification, or healthcare administration.
3.    Ability to motivate and organize people efficiently. 
4.    Excellent computer system knowledge and PC skills. 
5.    Ability to work under pressure and promote a positive working atmosphere.
6.    Ability to lead and manage diverse staff in a learning environment with frequent changes in department priorities. 
7.    Ability to recognize necessary changes in priority of tasks and allocation of resources, and act upon them as required to meet workload balance. 
8.    Possess effective communication skills both verbally and written. 
9.    Excellent critical thinking, decision-making, problem solving, and analytical skills required.

PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
1.    Living the Genesis Mission, Vision and Values: 
• Performs work in a manner that is quality focused.
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.
• Results oriented and focused on achievement of objectives.
• Acknowledges and responds to the diversity of people and the situation.
• Encourages peers (others) to be owners of change.
• Always makes the effort to anticipate and exceed customer needs and expectations.
• Possesses the ability to engage others with patience and understanding.
• Acts in a manner that creates positive first and lasting impressions.
• Demonstrates the ability to own issues until they are resolved.
2.    Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role…connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages confidential/sensitive information appropriately.
• Responds to requests in an appropriate and timely manner.
• Exits patient/customer encounters courteously, asking if there are additional needs that can be addressed.
3.    Promotes Patient and Employee Safety 
• Demonstrates safe Patient Handling (i.e. transfers, transport, care administration, nutrition, medication, etc.) 
• Demonstrates safe Materials Handling (i.e. appropriate use and disposal of chemicals, infectious wastes, etc.)
• Demonstrates appropriate knowledge of Infectious Disease precautions and use of proper protective equipment
• Demonstrates Slips/Trips and Falls Awareness.
• Actively contributes to maintaining a safe, clean and quiet environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1.    Works in an office environment and remotely; hybrid position. 
2.    Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds, and occasionally lift or move up to 50 pounds.
3.    Vision aptitude required: up close vision, peripheral vision, depth perception and the ability to adjust focus.
4.    Answers phones, uses a personal computer, scanner, copier, and fax, which require finger dexterity.
5.    May occasionally bend, reach, push, pull, stoop kneel, crouch or crawl.
6.    Employee may be required to travel to other departments/floors or travel to other locations.

This description reflects in general terms the type and level of work performed.  It is not intended to be all-inclusive, nor portray the specific duties of any one incumbent.

Thank you for your interest in employment at Genesis. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job.

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