PASC Pre-Certification Supervisor - Gainesville, GA Hybrid Schedule

nghs; Gainesville (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Northeast Georgia Health System is seeking a Supervisor Precertification to lead inpatient and outpatient scheduling, insurance verification, and denials monitoring within the Revenue Cycle.

You will collaborate with financial counseling, physician offices, and care teams, support timekeeping and training, and ensure adherence to CMS, EMTALA, and HIPAA.

Qualifications

• CPC Certification required (AAPC or AHIMA accepted).
• High School Diploma is required.
• Five years of pre-certification/insurance verification experience.
• Two years of progressive leadership experience.

Responsibilities

• Develop educational tools and training materials.
• Assist with timekeeping and training for staff.
• Resolve claim edit workqueues and monitor denial trends.
• Track staffing to meet patient demand and optimize workflows.
• Collaborate with physician offices and leadership to improve processes.

Skills

Interpersonal skills

Communication

Time management

Attention to detail

Multi-tasking

Analytical ability

Education

High School Diploma

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft Project

PowerPoint

Job description

Job Category: Revenue Cycle

Work Shift/Schedule: 8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role: Job Summary

The person in the role of Supervisor Precertification reports directly to the Manager of Precertification and is responsible for activities relating specifically to both inpatient and outpatient scheduled procedures and admissions, insurance verification and monitoring of pre-certification related denials. The PASC Precert Supervisor will work in conjunction with Financial Counseling, Physician Offices, Clinical Service Lines, Case Management, UR and PFS. This position will be responsible for assisting with timekeeping, training new hires and / or remedial training for current employees, trending errors, updating Standard of Works as necessary and enforcing NGHS policies and IT processes and Patient Access Policy and Procedures used at NGHS.

Minimum Job Qualifications

Licensure or other certifications: CPC Certification Required (AAPC or AHIMA certification accepted)

Educational Requirements: High School Diploma

Minimum Experience: Five (5) years of related pre-certification / insurance verification experience. Two (2) years progressive leadership experience required.

Other:

Preferred Job Qualifications

Preferred Licensure or other certifications:

Preferred Educational Requirements: Bachelors Degree preferred.

Preferred Experience:

Other:

Job Specific and Unique Knowledge, Skills and Abilities

Ability to test, analyse, troubleshoot and isolate complex problems

Demonstrated competency in Microsoft Office products: (Word, Excel, Microsoft Project, PowerPoint)

Excellent interpersonal skills

Ability to work tactfully and effectively with physicians, team members and the user community

Excellent written and oral communication skills

Excellent Time Management skills

Detail oriented and ability to multi-task

Understanding of Revenue Cyle and Regulatory Guidelines such as CMS, EMTALA, and HIPAA

Essential Tasks and Responsibilities

Development of various educational tools: Paper handouts, HealthStream Courses, Physician Web Site Help Pages.

Comfortable with 1-1 training or managing small groups on multiple computers if training an office staff.

Assisting in timekeeping responsibilities as needed

Resolving Claim Edit Workqueue accounts and keeping them below the set goal amount.

Improvement work trending for employees, denials, etc. as needed to improve any barrier related issues found

Ensuring daily staffing plans are adequate to cover the patient demands daily.

Tracking and trending data as needed for any barriers, creating workflows to improve such barriers and metrics to show improvement of process.

Utilizes current knowledge regarding education trends and methodologies

Anticipates and resovle routine issues that arise and provides input to Patient Access Leadership Team and System Administrator Revenue Cycle to enhance system functionality to meet customer needs.

Coordinates physician and physician office service requests and incident resolutions through the Patient Access Leadership Team and System Administrator Revenue Cycle if appropriate.

Provides on call support as needed

Provides visits to physician offices as needed to promote and maintain relationship

Provide increased visibility and support during all downtimes, planned and unplanned.

Assess ongoing educational needs of staff; develop and implement training plan to address deficiencies.

Familiarity with developing an educational assessment tool.

Understanding of physician needs and practice patterns and workflow in hospitals

Collaborate with Patient Access Leadership Team and System Administrator Revenue Cycle to optimize current systems to meet the needs of the patients.

Assist with development and implementation of future hospital systems

Participate in special projects as needed and performs other duties as assigned

Evaluation process to determine the level of effectiveness of all education programmes

Utilizes aggregate data, research, and trends when developing education programmes

Actively participates in related committees and task forces, including (but not limited to) the Operational Committees, Physician Office Managers meetings, Patient Access Leadership Team meetings and any other meetings that may arise within the scope of this position.

For evaluations, providing employee feedback to manager for employee's behavior and performance.

Demonstrates excellent detail management as well as possesses strong self-motivational skills, demonstrating consistent, reliable, credible, respectful and timely customer service.

Physical Demands

Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

Vision: Moderate, Occasionally 0-30% of time

Kneeling/Stooping/Bending: Occasionally 0-30%

Standing/Walking: Frequently 31-65%

Pushing/Pulling: Occasionally 0-30