Wilkes-Barre, Pennsylvania
Summit, New Jersey
Raleigh, North Carolina
Wilkes-Barre, Pennsylvania
Posted: 15-Apr-25
Location: Tampa, Florida
Categories:
Internal Number: 25014275
All the benefits and perks you need for you and your family:
·Paid Days Off from Day One
·Student Loan Repayment Program
·Career Development
·Whole Person Wellbeing Resources
·Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding thattogetherwe are even better.
Schedule: Full time
Shift: Days
The community you’ll be caring for:AdventHealth Tampa
· AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
· Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
· Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
· Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.
The role you’ll contribute:
Under general direction of the Manager of Utilization Management, supervises all functions of ensuring complete and accurate collection of insurance authorizations for assigned payers. Maintains effective working knowledge of assigned payers, staying in constant communication with provider representatives/contract managers. Monitors DNFB/DNSP by reviewing all department related work items by team, as well individuals, to ensure all accounts are processed and identifies barriers causing delay in billing. Reports all issues identified at quarterly JOC meetings at discretion of Manager. Performs supervisory duties in the absence of the Manager by overseeing the day to day operations. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies.
The value you’ll bring to the team:
· Plans, develops, organizes, and supervises Auth / Denial Support staff in daily operations of working accounts, payments, denials, auth correspondence and clinical requests as appropriate. Responsible for all insurance authorization outcomes in assigned areas. Lends support to clinical team as needed.
· Monitors Aging work items in work queues to ensure all accounts are worked timely and identifies barriers causing delay in billing. Follows up as appropriate with payers and contract manager for resolution. Reports all issues identified to department leadership and during JOC meetings at discretion of Manager.
· Monitors all accounts pending DNFB and DNSP daily ensuring timely review; escalates as needed to resolve issues holding accounts.
· Establishes and maintains working relationship with all payers, staying in constant communication with provider representatives/contract managers, ensuring contract language is followed, and if not, appropriate action is taken with contract management at the discretion of Manager.
· Focuses on process improvement strategies with special focus on insurance reimbursement outcomes to protect financial standing of AdventHealth. Reviews all financial reports available, communicates outcomes to team and leadership timely, and provides accurate statistical records and reports. Holds self and staff accountable for individual and team goals set by URM UM leadership. Evaluates staff in accordance with HR standards including giving constant feedback on productivity, accuracy, and any disciplinary action that is required including HR when appropriate.
· Monitors all department changes/updates to ensure communication with team by holding routine meetings as established by leadership including any continuing education that might be needed. Assists with monitors mandatory ALNs to ensure they are completed as required.
· Monitors all employees ensuring compliance with HIPAA and all other Federal Regulations are a priority followed.
The expertise and experiences you’ll need to succeed:
· 5 experience (including two years supervisory experience.
· 1 precepting experience) in Patient Access/Patient Financial Services Department or related area (registration, finance, collections, customer service, medical office, or contract management).
