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Supervisor Referrals and Authorizations


Company

Lancaster General Medical Grp

Cost Center

61026 Referral Office - West

Supervisory Organization

Utilization Mgmt & Financial Clearance

Grade

G11

Summary

POSITION SUMMARY: Plans, organizes and supervises all systems, processes, and operational support as it relates to Lancaster General Health’s professional referrals and authorizations including oversight of both day to day operations and departmental process improvement initiatives.  Ensures compliance with hospital policies, billing guidelines, and payer policies. 

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

  • Prepares/oversees time and attendance, absence management, and work schedule to meet the demands of our customers and workload. Assigns and prioritizes staff workload.
  • Performs functions of Referrals & Authorizations staff during high volume, staff absences, or other times to meet the goals of the overall department or to provide service to customers and stakeholders.
  • Maintains a high level understanding of the entire revenue cycle; maintains a thorough knowledge of the components for which supervisor is specifically responsible; maintains a thorough knowledge of staff processes at a supervisory level; anticipates changes in the referral and authorization workflow based on changes in the payer policies and billing guidelines and makes appropriate changes/recommendations.
  • Identifies work processes that can be improved upon, eliminated, or handled through electronic processes; breaks down identified problems into small components, understands underlying issues, simplifies and processes complex issues; understands the difference between critical and unimportant facts/details.
  • Monitors and coordinates the daily operations of the Referral & Authorization department to ensure compliance with hospital policies, payer policies, and billing guidelines; with the manager - develops, maintains and implements policies and procedures; manages process improvement and quality assurance.
  • Using reports, metrics and real time statistics, monitors staff and ensures that productivity and quality standards are being met at an individual and team level.
  • Promotes activities that will build relationships with the physician practices.  Facilitates educational offerings to the practices to improve processes.
  • Manages projects in collaboration with Information Services (IS); monitors and ensures IS compliance and support of project needs; identifies any system dysfunction or discrepancies and makes recommendations for resolving; contributes to and/or leads projects requiring high levels of internal customer interaction, coordination, strategization; develops implementation plans to include timelines and deliverables.
  • Communicates regularly with staff and others, as appropriate, to develop and facilitate timely and accurate information through staff meetings, emails, huddles, and follow-up procedures.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

  • Reviews, audits, and analyzes problematic accounts and providers direction for corrections, education, and policy updates.
  • Participates in administrative meetings, committees, and project teams as determined necessary.
  • Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

  • Associates Degree or equivalent experience
  • Two (2) to three (3) years of patient referral and authorization experience
  • Strong interpersonal skills
  • Strong written and verbal communication
  • Strong analytical abilities

PREFERRED QUALIFICATIONS:

  • Knowledge of the Revenue Cycle
  • Bachelors degree in a related field
  • Two (2) to three (3) years of management experience, preferably in a healthcare setting.

COGNITIVE REQUIREMENTS

Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.

  • The position requires the ability to attend to more than one aspect of a situation simultaneously.  It is highly likely that multiple task demands are going to be required of the individual at the same time.

New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.

  • A large portion of this position requires reliance on verbal memory and new learning.  Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job.  The individual must be able to attend to and process multiple bits of information simultaneously.  The individual must be able to organize and categorize this information effectively so that later recall is feasible.

Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.

  • The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions.  Some independent thought, planning or origination of options and solutions is necessary.  The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act.

Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products, Epic

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:

  • Sit:                          Continuously
  • Stand:                    Occasionally
  • Walk:                     Occasionally
  • Bend:                     Rarely
  • Push:                      Rarely
  • Pull:                        Rarely
  • Kneel/Squat:        Rarely
  • Reach:                   Rarely
  • Twist:                     Rarely
  • Balance:                Rarely
  • Climb:                    Rarely

Lifting: Degree of physical exertion is:

Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

  • Vision
  • Hearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS:

Exposure to hazardous conditions/ materials is negligible.

                                   

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

BURLE Full Time Posted on 02/25/2020