Hybrid Manager Heath Insurance & Prior Auth. Coords chez University of Rochester

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500183 Health Insurance Counseling

Work Shift:

UR - Day (United States of America)

Range:

UR URC 213

Compensation Range:

$67,276.00 - $94,149.00

Responsibilities:

GENERAL PURPOSE:
The individual in this position is responsible for shaping the quality, productivity, and efficiency of the Health Insurance and Authorization teams and identifying ongoing opportunities for process improvements and implementing them. This role will monitor daily administrative operations, suggest cost-effective alternatives, recommend revenue enhancement opportunities, manages day-to-day elements of the budget (e.g., overtime, expense trends, and manpower) monthly and implement effective policies for all operational procedures, maintain organized employee records, monitor supervisor’s performance, stay up to date with payer regulations and compliance, and contribute to the program’s overall performance targets. Authorization workflow involves managing health insurance determination (in and out-of-network, primary and secondary) and the operational strategy of the authorization process, from submission through follow-up and including authorization appeals. This position works in a high-performance, fast-paced, authorization-focused team environment, performing key revenue functions across designated services and specialties. Manages a small team of supervisors, and employees at the entry or intermediate level. This position provides on call after hours services seven days a week.

ESSENTIAL FUNCTIONS

Personnel Management      

• Oversee the supervisors and specialty staff, provide training and development, and evaluate their performance. 
• Counsel the supervisors to act on matters of discipline, promotion, salary, and other issues.
• Formulate teaching outline and determine instructional methods such as individual training, group instruction, lectures, demonstrations, conferences, meetings, and workshops and tailor those based on employees’ varying backgrounds, learning styles, and special needs.
• Provide supervisors with opportunities to observe, question, and investigate materials covered during the session.
• Establish guidelines and assessment tools to measure training effectiveness.
• Perform and provide feedback on evaluations for direct and indirect reports.
• Review and evaluate proposed promotions or terminations as appropriate.
• Participate and provide influence and recommendations in the recruitment process.
• Provide supervisors with guidance regarding assessment of performance, improvement plans and disciplinary processes.
• Provide supervision, leadership, coaching and counseling to direct and indirect reports.
• Ensures appropriate staffing levels, approves, or denies absence requests and reviews timecards for accuracy to assist with payroll processing. 
• Review department budget for accuracy and provide feedback to increase efficiencies in spending.

Operations Management

• Collaborate with supervisors and employees to gain knowledge of work situations requiring training and to better explain changes in policies, procedures, regulations, business initiatives, and technologies.
• Review and provide updates on HB Top Errors.
• Ensure Patient, DAR, account, claim edit work queues and high cost, ALC reports are worked daily and are followed up appropriately.
• Assist with third-party appeals at advanced levels escalated by staff.
• Lead and evaluate task activities and control deadlines.
• Disseminate expertise in health insurance products to supervisors and staff.
• Provide coverage to Director, fellow department Managers and Supervisors.

Interdisciplinary Processes

• Collaborate with the leadership team to enhance our departmental work quality and efficiencies.
• Collaborate with SMH departments to integrate operations with other components of URMC, such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management, Utilization Management, Social Work, Patient Accounts, Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance.
• Works closely with Transfer Center and Transplant teams to review after hours requests for insurance review seven days a week.
• Coordinate with external entities including patients, families, physician offices, third party payers, Department of Social Services, Department of Health, police departments, attorneys, MVA and WC carriers, outside hospitals, governmental agencies, and external review agencies.
• Advise and provide guidance regarding registration, insurance, and authorization to URMC and affiliates.

Policies and Compliance

• Perform audits and assist with quality assurance and compliance functions.
• Responsible for creating, reviewing, validating, and maintaining departmental policies and ensuring staff compliance.
• Manage, monitor, and continuously review the implementation of training policies and practices.
• Responsible for disseminating and ensuring compliance with Hospital Policies and procedures.
• Interpret third-party payer requirements and related regulations to ensure requirements are met through insurance bulletins and compliance reviews.
• Ensure departmental compliance with government or agency guidelines.
• Ensure Joint Commission compliance.

Planning

• Independently identify or collaborate with Director to identify strategic goals and objectives for the department and relay those to supervisors and staff.
• Organize staff meetings and maintain meeting minutes.
• Plan department annual program-related events.
• Perform ongoing assessment of program growth and anticipate staffing needs related to the creation of new positions and expansion of program.
• Review staff salaries for retention and recruitment purposes to ensure alignment with market rates and submit them to the Director. 
• Lead the preparation of recruitment efforts and interviews.

Other duties as assigned

MINIMUM EDUCATION & EXPERIENCE

• Bachelor’s Degree and 4 years of experience Required
• or equivalent combination of education and experience Required

KNOWLEDGE, SKILLS AND ABILITIES

• Experience in management, operations, and leadership.  Preferred
• Requires a high degree of professionalism, motivation, interpersonal skills, highly collaborative, self-starter, excellent verbal and written communication style. Preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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