GENESIS HEALTHCARE SYSTEM
 

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Position Details:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Department:

Financial Clearance

Overview of Position:

The Financial Clearance Manager is responsible for overseeing the financial clearance process, verifying insurance coverage, and securing prior authorizations. This role ensures compliance with insurance requirements, optimizes workflow efficiency, and supports healthcare providers in securing timely approvals; including but not limited to any scheduled service within the organization such as diagnostic testing, medical procedures, treatments, and medications. This position must maintain an awareness of payer guidelines and updates and proactively educate all stakeholders on changes to secure a standard authorization process. This role should leverage technology to achieve optimal efficiency, reduce preventable denials, and maximize patient access opportunities. This role plays a critical part in implementation of best practices to achieve the best outcomes with attention to quality, efficiency, and cost, while also enhancing the patient financial experience.

ESSENTIAL DUTIES
Process
1.    Oversee the submission, tracking, and resolution of prior authorization requests. This position works closely with all organizational departments and vendors to secure authorizations for all services scheduled within the system; this includes both employed and non-employed referring providers.
2.    Responsible for developing and maintaining infrastructure necessary to facilitate information collection and submission in order to obtain a timely prior authorization when required 
3.    Maintains fields within the billing system to assure compliance to billing and regulatory requirements, specifically related to authorization approval information. 
4.    Collaborates with clinical teams as necessary to obtain key information needed to obtain prior authorization with a special focus on creating standards and criteria within the medical record system referral form. 
5.    Handles patient complaints as needed with superb customer service. 
6.    Maintains up-to-date knowledge of third-party payer policies, regulations, and payer requirements. Ensures adherence to payer policies, healthcare regulations, and organizational Standard Operating procedures and programs; this includes collaborating with Payer Relations team to remain informed and compliant with evolving payer policies and federal guidelines. 
7.    Collaborates and serves as a liaison to Utilization Management Review department to assist with securing prior authorizations and maintaining knowledge of third-party payer requirements. 
8.    Identifies potential authorization or coverage issues to minimize claim denials, taking immediate action through education of staff or escalation of issues to payer relations team. 
9.    Proficient working with payer portals, EHR systems, and automated authorization tools, guiding direct reports with changes. 
10.    Collaborates closely with scheduling and registration departments on workflows, insurance verification processes, and communication of key elements necessary to secure a prior authorization timely; this includes various referral reporting  

Leadership
11.    Supervises and trains all staff responsible for checking and securing prior authorization, and quality and assurance of financial clearance processes.
12.    Responsible for leading the team and partnering with internal and external stakeholders in streamlining prior authorization workflows and reporting structures
13.    Develops a team structure that optimizes workflow and enables high collaboration with with revenue cycle operations to enable maximization of payer yield opportunities 
14.    Routinely reviews accuracy and quality metrics and works with team members to provide comprehensive training programs, refresher sessions, and robust digital reference guides embedded in the system 
15.    Holds team members accountable to meeting metrics that enable optimal payer yield performances, creating action plans when necessary to meet targets 
16.    Seeks opportunities to acquire more skills and abilities in support of professional and personal g