Offer summary

Qualifications:

High school diploma required, bachelor's degree preferred., At least 8 years of experience in admitting, patient registration, or pre-certification roles., Experience in supervisory or lead roles in healthcare settings., Knowledge of Medicare/Medicaid regulations and Epic software is preferred..

Key responsibilities:

Manage daily operations of pre-registration and pre-certification processes.

Lead and supervise staff, ensuring quality and productivity standards are met.

Coordinate with departments, payers, and providers to verify coverage and obtain authorizations.

Develop and implement policies to improve efficiency and compliance.

Job description

Position Title

Pre-Reg Pre-Cert Manager

Days - Full Time

Remote

Position Summary / Career Interest:

The Pre-Reg Pre-Cert Manager is responsible for the oversight of the pre-registration/ pre-certification policies and practices throughout the health system. In this role you woul dbe required to manage employees workflow and performance. Provides direction and leadership to Supervisors and respective staff. Assures staff productivity, quality and customer service are monitored and meet the departmental standards. Works in collaboration with multiple departments throughout the health system. Supports and adheres to the University of Kansas Health System's Code of Ethics and Business Standards.

Responsibilities and Essential Job Functions

Manages day to day operations for sponsored admissions, oversees the contact of patients’ employer and/or insurance company to verify coverage and benefits, obtain benefit level, patient liability, billing address and preexisting condition information. Management of pre-certification and/or authorization process. Complies with Medicare/Medicaid rules and regulations.
Provides leadership presence and guidance through direction and role-modeling. Conducts daily work que review, assists supervisors with workload prioritization and redistribution, reviews reports, assures appropriate account coding, utilizes day-end checklist of key activities, conducts walk-through of all areas. Uses financial concepts and tools to analyze situations and make financial decisions that support the achievement of short and longer-term Unit/Team objectives. Responsible to manage operational budget and staffing budget.
Responsible for daily operation of the pre-registration/pre-certification employees are contacting the patient, contacting responsible payers including government and non-government payers, contacting the patient’s employer, referring uninsured and underinsured accounts to the Financial Advisors, and taking any other necessary actions. Contacts supervisor and physician immediately of any restrictions denying admission, such as inability to obtain pre-certification or any lock-in program by any agency. Ensures the patient or family is aware of any denials or limitations.
Manages human resource functions such as interviewing, selection, orientation, education/training, feedback, performance evaluation, and policy and procedure development. Maintains personnel files, including documentation of appropriate staff orientation, competency, training, discipline and performance reviews. Oversees department timekeeping and payroll. Collaborates with HR concerning employee issues and performance. Conducts employee coaching, counselling, disciplinary actions and annual appraisals. Monitors staff adherence to hospital and departmental policies and procedures.
Collaborates with Director in developing policies and procedures that will increase pre-registration/ pre-certification efficiency. This includes the training, hiring, disciplinary action and evaluation of staff. Keeps Director informed of daily operational issues.
Performs reviews and internal audits to maintain standards of quality and quantity with emphasis on complete accuracy and timeliness of information gathered. Assures quality reviews and productivity reviews are being completed and feedback is given to staff for improvement.
Manages all WQs for registration/ pre-registration/ pre-certification. Assures supervisors are managing WQ volumes and staff are working accounts on a consistent basis. Reviews reports and looks for trending and need for educational / supplemental training.
Works closely with the clinics, hospital ancillary departments, referral specialists and Financial Advisors regarding potential complications regarding insurance coverage/ authorization. Updates and changes insurance or demographic information on an as-needed basis.
Establishes, attends and conducts meetings as necessary to support department functioning. Maintains an open issue log and reviews with Director and other Management staff to secure needed assistance in resolving issues and to promote accountability.
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

High School Graduate
Bachelors Degree in related field, or equivalent 8 additional years of admitting/patient registration, or pre-registration & pre-certification experience.

Preferred Education and Experience

Master's Degree
Epic experience
5 or more years of admitting/patient registration, or pre-registration & pre-certification experience. Including 2 years of lead or supervisory experience

Required Licensure and Certification