Manager-Insurance Authorization and Follow up at South County Hospital – Wakefield, Rhode Island

Job Summary

Under the supervision of the Director of Revenue Cycle, the Manager of Insurance Authorization and Follow-up is responsible for the leadership of insurance authorization staff, SCMG surgical scheduling staff, referral coordination staff, and accounts receivable follow-up staff.

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Core Duties:

• Responsible for the management of the Insurance Authorization Unit (IAU), SCMG Surgical Scheduling, Referral Coordination and accounts receivable staff (Revenue Integrity and Payment Variance)
• In collaboration with the Director of Revenue Cycle and Director of Decision support, identifying and escalating payer issues or any other source of unpaid, underpaid, or delayed revenues for accounts receivable.
• Ensure that Surgical Scheduling meets or exceeds productivity targets to book surgical procedures booked by SCMG providers
• Ensure that the Insurance Authorization Unit meets or exceeds productivity targets, and consistently secure authorizations for the full breadth and scope of services. Also responsible for working with the team to ensure speedy follow-up on denials or retro-authorization requests.
• Responsible for trending and follow-up on Revenue Cycle KPI’s such as accounts receivable, write-offs, denials, bad debts and any other relevant reports
• Collaborates with outside departments to ensure that all services are billed appropriately to reflect the full scope of services performed (in line with billing and coding rules/guidance). Also ensures that code or charge updates are made where appropriate.
• Collaborate with Case Management and UR department to secure inpatient or observation authorization as appropriate. If denied by the payer, working with UR to appeal the payer decisions where appropriate.
• Works closely with the Manager of HIM to optimize the coding process to reduce coding denials
• Works closely with Central Access leadership to optimize the registration process and increase the clean claim rate.
• Responsible for ensuring billing compliance with Federal, State, and local laws/guidelines
• In collaboration with the Team Leaders of Revenue Integrity and the Revenue Analyst: maintaining the Charge Description Master (CDM) for the hospital and South County Medical Group.