Summary:
This position is responsible for the management of the Pre-Authorization and Insurance Verification process for UNC HCS Physicians and Hospitals. This includes working closely with pre-services and patient access across all UNC HCS Entities to ensure problems are quickly identified and resolved. Works closely with other Revenue Cycle Directors, Managers and Supervisors to eliminate delays in process and to maximize collections for the services provided. Responsibilities include operational analysis, financial analysis, problem resolution, personnel management, and performance improvement.

Responsibilities:

1. Patient Financial Services - Responsible for managing all Pre-Authorization and Insurance Verification activities for physician and hospital services in the Pre-services unit. Responsible for managing pre-service calls to patients to advise them of their payment responsibility and to secure deposit prior to care being provided. Responsible for planning, developing, and implementing new systematic approaches to optimizing the authorization and eligibility processes. Responsible for maintaining and exceeding organizational goals for the AR by using all systems efficiently. Responsible for identifying trends and optimization opportunities that will enhance staff productivity. Manages and monitors authorization and insurance verification processes, as well as, authorization and eligibility edits and denials to ensure that all patient insurance eligibility is verified. Responsible for ensuring all professional and hospital authorizations and pre-certifications are obtained. Prepares and maintains reports on insurance verification and authorization trends and presents in leadership meetings. Establishes and measures outcomes against department goals and deadlines, and provides direction and leadership to subordinate staff. Works closely with the all Revenue Cycle Leadership across all UNC HCS Entities to minimize denials and achieve organizational goals.

2. Leading People Leads people toward meeting the organization's vision, mission, and goals. Provides an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts. Ensures that team treats sensitive or confidential information appropriately. Works to improve and reinforce performance of others. Delegates assignments, clarifies expectations and holds others accountable for achieving results related to their area of responsibility. Encourages workforce engagement by building a commitment to excellence. Works collaboratively toward solutions that accomplish organizational objectives. Develops effective staff professional development plans.

3. Leading Change Initiates and manages the change process, taking steps to remove barriers or accelerate its pace. Communicates a compelling vision and need for change that generates excitement, enthusiasm, and commitment to the process. Clearly communicates the direction, required performance, and challenges of change to all involved parties. Identifies and enlists the support of key individuals and groups to move the change forward. Obtains and provides resources to implement change initiatives. Serves as a role model by demonstrating commitment to innovation and continuous improvement in organizational performance.

4. Results Driven Exceeds departmental and organizational goals and customer expectations. Makes decisions that produce high-quality results by applying knowledge, analyzing problems, and calculating risks. Delivers high-quality services and is committed to continuous improvement. Understands the overall financial performance of the organization and applies financial concepts and practices to establish and maintain realistic budgets. Uses financial information to monitor overall financial status of operations.

Other Information

Other information:
Education Requirements:
• Bachelor's degree in an appropriate discipline.
Licensure/Certification Requirements:
• No licensure or certification required.
Professional Experience Requirements:
• Five (5) years of progressive experience in related field.
Knowledge/Skills/and Abilities Requirements:
• Understands and appropriately applies principles, procedures, requirements, regulations, and policies related to specialized expertise.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: PFE Coverage Coordination

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.