National Director, Intake bei undefined
undefined · Arlington, Vereinigte Staaten Von Amerika · Hybrid
- Senior
- Optionales Büro in Arlington
TITLE: National Director, Intake
REPORTS TO: Chief Clinical Officer
EMPLOYMENT STATUS: Fulltime
JOB SUMMARY:
Responsible for leading AOM’s national intake operations teams through referral triage, insurance verification, benefit investigation, prior authorization, and financial clearance for core therapy lines and sites of care. The National Intake Director will develop and implement scalable intake workflows, automation, and best practices to support AOM’s Centers of Excellence model in meeting the demands of patient growth across multiple regions of the country and business lines.
Works as a liaison between all departments within AOM to improve start of care and reauthorization processes. Works with account executives to understand their unique referral source needs and triages appropriately. Manages activities related to referral processing, obtaining applicable medical documentation, collecting patient financial responsibility, and accurate entry into applicable applications. Responsible for following standardized referral processes and ensuring standards and metrics are met associated with timeliness and accuracy of referral entry. Ensures staff is appropriately trained and held accountable for achieving departmental standards and goals. Identifies root cause issues and works with others to improve overall processes.
REQUIREMENTS
- Education:
- Bachelor’s degree in healthcare administration, nursing, business, or related field preferred.
B Experience
- 5 -10+ years of progressive experience in home infusion or specialty pharmacy intake operations, with 5+ years in leadership.
- Proven success managing multi-site or national intake teams within a complex, payor-driven healthcare environment
- Excellent communication, time management and organization skills.
- Expertise with CPR+, or similar patient intake systems; experience with analytics and workflow automation tools preferred.
- Exceptional communication, leadership, and change-management skills with the ability to influence across departments and executive levels.
- Strong understanding of payor contracting, medical and pharmacy benefit design, and reimbursement methodologies (AWP, ASP, case rate, per diem, etc.).
- Fulltime Employment:
- 40hrs per week. Work week is Monday thru Friday
- Schedule determined by supervisor.
JOB RESPONSIBILITIES
- Lead national intake and reauthorization teams in ensuring timely and accurate referral triage, insurance verification, benefit investigation, prior authorization, and financial clearance, including timely communication to management, clinical ops, and sales teams. Analyze and report to management any trended issues.
- Enhance operational capabilities of the intake and reauthorization teams by overseeing team structure and organization, monitoring departmental and organizational performance metrics, resolving process gaps, and designing scalable and resilient processes capable of meeting patient growth demands within AOM’s different sites of care across the country.
- Collaborate with other AOM leaders to develop, implement and maintain seamlessly integrated service lines expected from a Center of Excellence in chronic infusion therapies through scalable workflows, automation, and meaningful patient engagement strategies.
- Support clinical intake team members in the review of medical information as required to determine the “medical necessity” of the prescribed therapy and oversee the preparation of appeals on any claims denied due to authorization/medical necessity issues. Assist with any claims denied due to authorization/medical necessity issues and analyze/report to management any operational issues identified.
- Work in concert with AOM’s National Director of Patient Advocacy and Access in the coordinated triaging of high acuity, medically fragile patients, seamlessly and with urgency.
- Collaborate with Revenue Cycle to align intake data quality and pre-billing readiness with claims submission and denial prevention.
- Analyzes and reports to out to stakeholders, any trends by the insurance carriers regarding profitability, eligibility, coverage and/or authorization of services that may affect patients requiring home infusion services.
- Oversees the timely verification of Medicare coverage criteria for Medicare patients. Works directly with clinical staff to ensure all coverage criteria is met and communicates with management, clinical, sales and reimbursement staff for additional information needs and/or coverage criteria has been met.
- Perform audits on a quarterly basis a sampling from each therapy to ensure sufficient authorization secured. Analyze and report outcomes. To include any trends or suggestions identified that concern coverage/medical necessity of therapy.
- Foster a culture of continuous improvement and operational excellence through training, performance reviews, and recognition of top performance.
- Responsible for review and guidance of training of new staff and new departmental leadership in the duties, roles and expectations of the team. Assess staff as needed for level of learning, productivity and adherence to policy and procedures.
- Ensure intake operations meet all accreditation and payor requirements, including documentation, verification, and privacy standards.
