PASC Pre-Certification Supervisor - Gainesville, GA Hybrid Schedule

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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, analyze, 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 resolves 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 programs

• Utilizes aggregate data, research, and trends when developing education programs 

• 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%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.