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Work Shift

Day

Work Day(s)

Monday-Friday

Shift Start Time

8:30 AM

Shift End Time

5:30 PM

Worker Sub-Type

Regular

Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.

Job Description

Provides operational and strategic leadership and accountability for Utilization Management and front-end revenue cycle activities in support of the system's mission and values. Obtain and validate patient demographic and insurance information needed to expedite reimbursement on Accounts Receivable while working closely with Physicians and Case Management to ensure quality and appropriateness of patient care and resource utilization management. Collaborate with Patient Accounts, Case Management, and IS&T Department to ensure verification, authorization, and denial management is in place. Function as the system resource and role model for revenue cycle functions including scheduling, order management, admitting, pre-certification, authorization, and financial assistance/charity.

Experience

Minimum 5 years management experience in patient access and/or utilization review

Preferred Qualifications

MBA

Education

Bachelor’s Degree in Nursing or Sciences or equivalent experience

Certification Summary

No professional certifications required

Knowledge, Skills, and Abilities

Demonstrated management skills and working knowledge of insurance industry pre-certification and utilization/case management criteria such as InterQual and/or MillimanMust possess excellent communication, organizational, and interpersonal skills as well as aptitude for conflict resolution, problem solving, and staff developmentDemonstrates the following skills in accomplishing job duties and responsibilities:Personal organization and time managementHuman relations and teamworkPersonal adaptabilityPersonal motivationListening

Job Responsibilities

Provide strategic direction and vision to optimize implementation of front-end revenue cycle and utilization management for all hospital campuses and neighborhood locations.Provide oversight and promotion of quality of care, appropriateness of patient care, resource utilization management, and the development of policies and standards for the Utilization Management Program as co-chair of UM Committee and through collaboration with Medical Management.Develop and execute current Utilization Management Plan for the hospital campuses, ensuring ongoing compliance with state and federal regulations.Manage human and fiscal resources to improve system's revenue cycle cash receivables through implementation of an effective financial clearing program, accurate data collection, insurance verification, pre-certification, and authorization.Manage uninsured accounts receivables for the system through maintaining current knowledge of state, federal, and non-governmental available financial funding, or resources, as well as developing professional partnerships. Implement Children's system-wide Financial Assistance/Charity policies and processes to ensure compliance with regulations as well as to improve organization growth and value in the community.Provide oversight for front-end actions necessitated by denials received through development and implementation of front-end revenue cycle policies for the system and partnership with physician practices, patient accounting, case management, HIM, coding, and IS&T.Provide leadership and direct system-wide education/training to all patient access areas (all hospital and neighborhood centers) to increase system-wide technical and operational knowledge of the dynamic and complex payor requirements and state and federal regulations for front-end revenue cycle activities.Indirectly provide leadership to all patient access areas which do not have direct reporting relationship or accountability.

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Director/Senior Director