Manager of Medical Insurance & Central Prior Authorization

Overview

Manages the daily activities of Patient Access Medical Insurance and Prior Authorization departments to ensure high quality customer service and improve revenue cycle activities for prior authorizations, documentation, billing and claims. Understands regulatory and third party payer guidelines for admissions, discharges, ambulatory visits, diagnostic imaging, inpatient and outpatient services, billing, to ensure authorization functions and staff remain in regulatory compliance. Reviews SVR (Staffing Variance Reporting) to ensure that budget guidelines are met, and to provide appropriate resources based on the department volumes and activities. Oversees training, education, and staff development by department supervisor, leads, and trainers. Promotes cross training and develops staff to enhance job function and responsibilities so that maximum flexibility within Patient Access is achieved. Coordinates and communicates process updates and flows with internal departments at Carle and external departments when necessary, to ensure that Prior Authorizations are in place by the patient's service date to increase patient satisfaction, reimbursement to the organization, and problem resolution. Takes an active role in denials reduction efforts, timely filing expectations for registration and authorization claim error resolution, and serves as a SME (Subject Matter Expert) for Revenue Cycle operations for registration and authorizations.

Qualifications

Certifications :

• Certified Healthcare Access Manager (CHAM) within 2 years

Education :

Work Experience :

Responsibilities

About Us

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information : human.resources@carle.com.

Compensation and Benefits

The compensation range for this position is $37.44per hour - $64.4per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.

Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org / benefits.