Position Purpose: Oversee day to day functions of the call center that provides pre-authorization and referral services to physicians for plan members.
Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factors
Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
Promote compliance with federal and state regulations and contractual agreements.
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
Facilitate on-going communication between utilization management staff and contracted providers.
Bachelors degree in related field or equivalent experience.
4+ years of nursing experience.
Call center/customer service experience and working knowledge of call center technologies, data, and reporting.
Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
VIEW JOBS1/12/2019 12:00:00 AM2019-04-12T00:00RESPONSIBLE FOR:
Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for basic and moderately complex hospital outpatient visits. Obtains pre-certification or pre-authorization prior to the scheduled service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notifies the payer of admission if required.
MINIMUM EDUCATION REQUIRED:
High school diploma or GED
MINIMUM EXPERIENCE REQUIRED:
Two (2) yrs exp in Healthcare Revenue Cycle or related healthcare experience
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Three (3) years of previous related healthcare Revenue Cycle experience within precertification/authorization experience preferred. A Bachelor's degree from a recognized college or university preferred. Certification with Healthcare Financial Management Association, or Certified Revenue Cycle Representative preferred. Prior Epic experience preferred. Completion of medical coder training program is preferred.
VIEW JOBS1/17/2019 12:00:00 AM2019-04-17T00:00<p><img title="" alt="" src="https://workablehr.s3.amazonaws.com/uploads/photos/40063/2e4fc76ccba513f22f71011d7d4268dd.jpg" width="279" height="99" style="width: 279px; height: 99px;"></p><p>Are you a skilled and passionate Registered Nurse eager to make a difference in someone’s life? Do you want to be a part of the newest "highly recommended" home care team in Atlanta? Advanced Care Partners is looking for an RN that is committed to providing excellent care, building relationships, and supervising other caregivers.</p><p>ACP is one of this year’s Inc. 5000 fastest growing companies. Based in Atlanta, GA we offer career opportunities for the right individual! If you are looking for opportunities to grow with an organization, contact us now.</p><p><strong>Requirements</strong></p><ul> <li>Current RN with qualifications to practice in the state of GA</li> <li>At least 2 years experience with home health, long term care, and/ or acute care nursing</li> <li>COMP NOW experience preferred</li> <li>Preferred experience with vents, trachs, G-tubes, CVL’s</li> <li>Current CPR certification</li> <li>Evidence of negative TB skin test or chest x-ray</li> <li>Satisfactory criminal background check and a negative drug screen</li> <li>Home Health Experience a plus</li> </ul><p><strong>Benefits</strong></p><ul> <li>Hands-on training</li> <li>Supervisory experience</li> <li>Weekly pay</li> <li>Positive Work Environment</li> <li>Schedule flexibility</li> <li>Medical, Dental, Vision, and Life Insurance</li> <li>Awards and Recognition Programs</li> <li>Paid- Time Off</li> </ul>Advanced Care PartnersAtlantaGA