POSITION SUMMARY:
Under the direct supervision of the Corporate Director, Revenue Cycle, the Manager, Admissions drives a Admissions Team towards exceptional performance. Having financial and operational accountability over Nexus Health Systems patient admissions, the Manager, Admissions provides leadership to the Admissions Department operations such as, but not limited to, referral management, patient census, payer-specific admission criteria, authorization denial management, and data analysis. More so, the Manager, Admissions provides on-going leadership to day-to-day operations, supporting his/her team as opportunities presents, as well as collaborating across the health system in effort to meet organizational objectives.
JOB SPECIFIC RESPONSIBILITIES:
•A model employee of GOPTIC values
•Fosters a learning environment
•Maintain utmost level of confidentiality at all times
•Adhere to health system policies and procedures
•Demonstrate business practices and personal actions that are ethical, and adhere to corporate compliance and integrity guidelines
•Maintains a sense of professional and self-validation
•Ability to communicate effectively with all stakeholders across the health system
•Embodies a team player persona, and illustrate team payer dynamics to support a strong Admissions Team
•Responsible for promoting adherence to applicable State/Federal laws and regulations and the program requirements of accreditation agencies and Federal/State and private health plans in requests for third party authorizations
•Providers leadership to an Admissions Team
•Drives the admission process for Nexus Health Systems (NHS) in efforts to meet census goals
•Ensures Admission Coordinators are completing all referral tasks timely and accurately
•Establishes priorities and functional standards for the Admissions Department
•Exercises good judgment when addressing and resolving issues
•Meets or exceeds monthly census goals for the Admissions Department
•Manages the day-to-day admission area operations and immediate questions or concerns
•Leads overall admission flow, and addressing unusual occurrences, circumstances, or discrepancies to admissions workflow
•Leads the discovery of root cause authorization denials and implement denial management strategies for denial prevention
•Provides leadership to on-going quality assurance audits in conjunction with departmental policies, ensuring the Admissions Team is exercising operational objectives
•Oversight to aging referral requests, escalating referral request as needed for timely decision making
•Oversight to operations to identify problematic activity impacting referral aging, authorization denials, and referral close-outs for the Admissions Department
•Oversight to telephone calls, ensuring calls are handled with exceptional Customer Service, and are escalated to leadership as needed
•Develops short-term and long-term strategies to meet or exceed departmental and organizational KPI's,
•Recommends and/or implement process improvements with proven and effective data analysis
•Exemplify excellent Customer Service in communicating internally/externally to stakeholders in efforts to obtain necessary documentation for in-coming referrals
•Oversight to referral authorization requests to prevent timely filing denials
•Oversight to documentation of referrals and authorization, and provides leadership to the appropriate actions on in-coming referrals
•Mandatory to drive a reduction in referral aging, while working collaborative with stakeholders acorss the health system to render decisions on in-coming referrals
•Participates and/or leads departmental meetings, while fostering an environment of teamwork and collaboration
•Serves as a subject matter expert for the Admissions Department to executive leadership
•Consults with patients and/or guardians to discuss financial obligations, and presents payment options for self-pay portions
•Immediately informs stakeholders of significant operational issues, such as, funding, authorization denials, payer requirements
•Oversight to personnel needs, such as, but not limited to bonus payouts, call-ins, PTO requests, hiring, disciplinary actions, termination
•Develops, adhere, and maintains departmental policies and procedures as necessary to support departmental goals
•Develops departmental reports, and routinely distributes to stakeholders as needed
•Performs other duties as assigned.
POSITION QUALIFICATIONS:
EDUCATION:
•Bachelor's Degree preferred, or minimal two years of relevant work experience
EXPERIENCE:
•Two (2) years of healthcare experience, within a Revenue Cycle setting
LICENSURE/CERTIFICATION:
•Certified Revenue Cycle Representative (CRCR), preferred