The Manager of Verification is responsible for managing the day to day insurance verification, authorization process for Hospice, Home Health and Physician Billing. Establishing and/or maintaining positive relationship with organizations care partners i.e. Nursing Home Administrator/designee, third party payors and vendors. In addition assess and implement short and long term goals to ensure efficient functioning and internal and external satisfaction.
- Minimum five (5) years of related supervisory insurance verification and authorization experience, preferably in a consolidated business office environment. Bachelor’s degree strongly preferred.
- Strong management skills including motivating and mentoring people at all levels, training, establishing departmental policies and procedures and managing human resource issues of staff supervised.
- Customer service skills, interpersonal skills, ability to work independently, ability to work with a team, critical thinking, organizational skills, and knowledge of regulatory requirements appropriate for the position.
- Knowledge of third party billing and regulations required; knowledge of state and federal collection regulations preferred.
- Ability to manage in a fast pace environment, remaining proactive, detailed oriented, resourceful and efficient, with a high level of professionalism.
- Strong computer skills with Excel, Word, PowerPoint, and database management.
- Requires excellent written and oral communication skills.
- Valid driver’s license and automobile insurance.
- Ability to travel to off-site locations.
- Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Leadership Success Factors: (Managers, Directors and Administrators)
- Express thoughts and ideas clearly. Adapt communication style to fit audience.
- Originate action to achieve goals.
- Management Identification. Identify with and accept the problems and responsibilities of management.
- Make realistic decisions based on logical assumptions which reflect factual information and consideration of organizational resources.
- Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitors results.
- Use appropriate interpersonal styles and methods in guiding others toward task accomplishment.
- Work Standards. Set high goals or standards of performance for self and others. Compel others to perform
- Tolerance for Stress. Maintain stability of performance under pressure and/or opposition.
- Generates and/or recognizes imaginative, creative solutions in work related situations.
- Allocate decision making and other responsibilities effectively and appropriately.
- Staff Development. Develop the skills & competencies of subordinates.
- Organizational Sensitivity. Perceive the impact and the implications of decisions on other components of the organization.
- Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
- Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance.
- Provide leadership and direct daily activities of direct reports and communicate organizational information, goals and policies.
- Serve as an advocate for employees by eliminating barriers, assisting employees in their personal development, and act as a liaison between Patient Accounting and other departments.
- Interact with other department managers to improve processes/procedures from both an operational and revenue cycle perspective with the primary objectives of accurate billing, reimbursement maximization, and increasing cash flow as it relates to insurance verification and obtaining accurate authorization for services.
- Develop and maintain positive relationships with Nursing Home Administrator/designee.
- Audit and approve monthly Hospice Nursing Home Room and Board invoices.
- Ensure Medicare Face to Face billing regulations is met.
- Ensure monthly Medicare and Medicaid patient insurance revalidation is performed and documented.
- Partner with Medicaid eligibility vendor and oversee process to ensure timely account resolution.
- Audit and approve monthly Medicaid eligibility vendor invoices.
- Ensure that departmental hospice, home health, physician insurance verification and authorization procedures are followed.
- Assist Administrator of Revenue Cycle in third party payor and/or governmental audits.
- Participate in meetings and committees as required and attend training programs to include in-service lectures and seminars as requested.
- Maintain relationships with third party payers to establish mutually acceptable procedures to resolve authorization issues.
- Create, compile, analyze and present verification/authorization performance metrics to Administrator of Revenue Cycle.
- Identify opportunities for process improvements and or automation and implement new procedures.
- Participate in Revenue Cycle month end close process.
- Participate in annual budget projections and monitors department’s monthly budget.
- Responsible for special projects and all other duties as assigned.