Job Description

Summary
The Outpatient Financial Clearance and Authorization Manager is responsible for functions related to patient financial counseling (PFC), and financial clearance activities that include timely procurement of patient estimates, insurance authorizations and denial management related to scheduled outpatient services. Manage progress toward established goals, adjusting priorities and strategies as needed.

Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Responsibilities*
Manage operations of the outpatient financial clearance, centralized outpatient authorization and patient financial counseling unit to include:
Insurance verification, benefit eligibility, prior authorization/notification requirements, patient estimates, pre-collections and patient education and redirection.
Customer service, patient financial assistance, resolve clinic, billing and patient benefit and coverage inquiries.
Communicate the vision of patient financial advocacy to staff, team leads, supervisors and others who impact the patient financial experience
Develop department goals, initiatives, KPI's, management reports and scorecards that align with the ideal patient financial experience
Develop management skills of supervisor (s) by coaching and delegating while managing risk and ensuring accountability for delegated items.
Act as a liaison for authorizations, financial clearance, and financial counseling. Cultivate mutually beneficial relationships across the continuum of Revenue Cycle including clinics, payors, billing, coding, HITS and other Revenue Cycle departments.
Review staff productivity reports. Conduct regular meetings with auditors, supervisors, team leads and senior management to discuss productivity statistics and trends
Review and evaluate quality assurance (QA) data; implement improvement at the unit level to minimize errors; evaluates key performance indicator (KPI) data; identify opportunities to increase efficiency and implement performance improvement projects.
Employ Lean methodology to standardize work, surface problems, find efficiencies, eliminate waste, and develop problem-solving skills of supervisor, team leads, and staff.
Actively participate in the evaluation and implementation new technology.
Adjust workflow processes and work queues to ensure staff are working efficiently and prioritizing appropriately.
Interview, select and orient new employees, setting hours of work and workload assignments in conjunction with the supervisor and director.
Ensure supervisors and staff are adequately trained and make hiring, disciplinary, and termination recommendations.
Conducts annual performance evaluations.
Investigate, distribute, and resolve insurance and billing issues that are related to authorization, financial clearance and financial counseling activity.
Complete root cause analysis on denials and no-authorization write-offs and follow up with staff and customers to educate and implement processes to ensure positive outcomes.
Intercede with difficult customers and/or cases requiring in-depth knowledge of the prior authorization, financial clearance and financial counseling workflows.
Attend and/or lead internal and external departmental meetings as needed or requested.
Coordinates special projects related to financial clearance, financial counseling and authorizations as assigned.
Required Qualifications*
A Bachelor's degree in, Healthcare Administration, Health Information Technology, Business or other healthcare related field, or equivalent amount of years' experience.
5+ years management experience.
5+ business office experience within a healthcare setting is necessary.
Knowledge of health insurance, third party payers, government regulations and ICD-10 and CPT coding are required.
Strong written, verbal, and interpersonal communication skills, problem solving, decision making, and negotiation skills are necessary.
Excellent computer application skills are required.
Strong dedication to customer service, ability to be flexible and work within a team-focused, participative management framework is required.
Desired Qualifications*
A Master's degree in a healthcare or business-related field and prior experience working in Prior Authorization, Financial Clearance, or Coding.
Coding background is strongly desired.
Previous project management experience is preferred.
Understanding and ability to interpret medical terminology and insurance benefit information is preferred.
Considerable knowledge of university policies, procedures and regulations is desired.