Supervisor: Pre-Service

Education/Training:

Check ALL that Apply:

X

High school diploma or equivalent.

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Associate’s degree or advanced college level courses in a related field or three (3) years equivalent experience is required.

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Successful completion of courses in computer and medical terminology.

Experience:

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Minimum of two (2) years in prior authorization and utilization review experience is required.

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Minimum of two (2) years supervisory or management experience is required.

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Electronic health record (especially, Cerner) experience is strongly desired but not required.

Special Skills, Licenses or Certifications:

X

AHIMA or AAPC certification is strongly desired but not required.

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Knowledge of Medicare, Medicaid, Blue Cross, Commercial and other insurance programs is required.

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Working knowledge of clinical guidelines, medical necessity guidelines related to pre – service certification.

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Must have strong working knowledge of Microsoft Office, Access, data entry and spreadsheets.

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Computer skills sufficient to utilize email, documents, spreadsheets and project management software. 

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Current AHA BLS (Heart Saver) certification is required.   

Language Skills:

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Demonstrates ability to read, write, and clearly express one’s self in English 100% of the time.

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Additional languages are desired but not required.

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Demonstrates ability to listen.

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Demonstrates ability to express or exchange ideas by means of spoken work, to impart oral information to others or the public and to convey detailed spoken instructions to others accurately, loudly, or quickly.

Work Environment:

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Work is performed in an office setting with exposure to work stress, environmental stress and frequent interruptions; noise level is moderate; frequent daily communications with patients, employees, vendors and/or the public. 

Cross-Training of  

Position: 

X

PSMC cross-trains job positions.  This job description must cross-train to be able to effectively perform the job position(s) of:   Specialist: Pre – Certification.

Supervisory Responsibilities:

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This position IS responsible for supervising other personnel, including involvement in on-boarding, off-boarding, termination, coaching / discipline and annual performance reviews. This position is also responsible for ensuring staff competencies as appropriate.

Job Hazards:

X

Exposure to blood, bodily fluids and communicable disease. 

X

Physical strain due to repetitive tasking, sitting.

X

Potential exposure to verbal and / or physical abuse.

X

Liability due to current public consciousness. 

Culture:

Adheres to our standards of conduct and culture (WISER) as defined by our policies and procedures including maintaining, always, an attitude of positive teamwork, compassion, integrity, and respect for our patients, visitors and staff.   

Demonstrates commitment to service excellence and promotes positive patient, visitor, and employee experiences. 

Establishes and maintains effective working relationships with others (i.e., co-workers, supervisors, patients, visitors, vendors of PSMC and the public). 

Works effectively on PSMC/department team matters and recognizes situations which require teamwork. 

Quality:

Must consistently demonstrate compliance with organizational-wide competency statements and performance criteria based on established quality and key performance indicators. 

Safety:

Participates in employee training, disaster preparedness and emergency events. 

Reports potential safety issues as soon as possible. 

Demonstrates safe operation of equipment and uses supplies / materials / chemicals as directed by instructions for use. 

Wears non-slip footwear to prevent fall and/or injury. 

Follows established policies and procedures for employee illness and/or exposure to illness/disease.  Does not come to work sick. 

Service Excellence:

Demonstrates proper phone etiquette when talking on the phone for business. 

Answers phone messages promptly, by the end of the business day or as established by your department.

Demonstrates proper email etiquette when utilizing PSMC email account. 

Answers email messages promptly. 

Demonstrates a willingness to perform tasks and complete assigned work, does not leave unfinished tasks for others to complete.

Organization-Wide Requirements:

Complies with all PSMC policies including, without limitation, timely attendance, code for dress and decorum, no conflicts of interest, no harassment, fragrance free, use of personal devices at work etc. 

Complies with all PSMC and department procedures, rules and directives. 

Check email at least once daily when on-shift (full time employees); check email at least once weekly and/or when on-shift (part-time / per diem employees).   

Maintains strict confidentiality of all patients matters and recognizes situations where confidentiality should be maintained even if not legally required.  Note: All employees must sign a confidentiality agreement with PSMC stating that information will not be shared with any entity or individual unless authorized or necessary for patient care.  Breaches of confidentiality will result in immediate disciplinary action up to and including dismissal from employment. 

Possesses computer knowledge / skills and the ability to learn and adapt to new programs and software. 

Keeps personal contact information updated in Human Resources and in PayCom. 

Sets up desk phone in compliance with established PSMC protocol.  Assures name is associated with the phone assigned to you, if applicable. 

Utilizes away messages when you are not in the office and responding to calls, if applicable. 

Sets up email signature in compliance with established PSMC protocol.

Utilizes away messages when you are not in the office and responding to emails.

Demonstrates the ability to perform CPR 100% of the time.

Demonstrates the ability to work and multi-task at a rapid pace with numerous interruptions 100% of the time.

Displays the ability to work independently with high self-motivation and directional initiative.

Displays the ability to cope and remain calm in escalating circumstances.

Participates in departmental inventory process periodically.

Attends, at least, 50% of all scheduled department staff meetings.

Performs other duties, as assigned by a supervisor. 

Departmental Responsibilities:

Meets all standard job requirements.

Leadership Qualities and Characteristics:

Consistently demonstrates commitment to safe, quality patient care and friendly service to the patients and community.

Fosters a participatory organization climate that is open, positive, reinforcing and supportive to employees

Promotes a culture of high performance and continuous improvement that values learning, commitment to quality and collaboration

Serves as an advocate and chief spokesperson for the department, utilizing honest, transparent and consistent communication.

Works effectively and collaborates with others to achieve shared goals with others in a tactful and respectful manner.

Demonstrates leadership, integrity and courage by making and supporting decisions that support the organization’s mission and goals.

Accountability:

Establishes standards and clear expectations in all areas – job performance, training, continuing education, certifications, conduct and adherence to department and organizational values.

Holds self and staff accountable in a consistent and respectful manner.

Promotes effective actions for positive employee behavioral change and demonstrates decisiveness and fairness when determining discipline.

Completes multiple projects while keeping focus on constant improvement to current programs.

Interpersonal Skills:

Communicates effectively, keeping leadership and team members informed and involved.

Treats people with respect, recognizes individuality and is fair and equitable in all interactions.

Demonstrates critical thinking skills in problem solving tactics. Uses sound and fair judgement in a calm and professional manner.

Demonstrates adaptability and flexibility when new information becomes available.

Works collaboratively with others, communicates the department’s vision and strategy across all levels of the organization, and builds consensus around key initiatives and projects.

Establishes and maintains respectful and effective relationships with providers, employees, patients and managers/directors/Senior Leadership.

Ability to handle high stress situations, rapid pace, multiple issues, interruptions and matters requiring sensitivity.

Able to work independently, meeting essential job functions, deadlines and priorities, while also utilizing available resources when needed.

Human Resource Management:

Responsible for maintaining a culture that exhibits professionalism, positivity, and efficiency where all members of the department have equal opportunity to succeed.

Provides opportunities for staff development and cross-training as needed.

Assists the Director of Revenue Cycle to prepare individual employee evaluations and performance improvement plans based on field performance and management observations.

Shares organizational priorities with all staff members.

Conducts timely and informative meetings with department staff emphasizing open and truthful communication.

Participates in the recruiting, interviewing and fair selection for new staff and works hand-in-hand with the Director of Revenue Cycle to ensure positions are filled quickly with quality candidates.

Ensures that problems identified are addressed per policy and in a timely manner.

Schedules staffing for effective and efficient delivery of services.

Demonstrates commitment and sensitivity to diversity, cultural, gender, and sexual preference, religious and other individual differences and adapts behavior and communication to accommodate these differences.

Ensures all department personnel:

• Complete required orientation programs;
• Receive specific department training by the department supervisor or his/her designee;
• Are assessed periodically for training/education needs;
• Participate in department meetings or other meetings to understand current goals of PSMC, interdepartmental matters, policies and procedures, etc.; and
• Participate in educational trainings/programs and staff meetings.

Standards and Compliance:

Ensures department compliance with all applicable federal, state and local regulations.

Monitors compliance with policies and procedures and initiates corrective measures in a timely manner, as required.

Possesses the knowledge and ensures adherence to industry and regulatory practices to ensure environmental protection and worker safety.

Assures effective guidelines, protocols, and department policies are interpreted for personnel, enforced and timely updated in the policy manager system. Maintains the department in a state of readiness for unannounced licensing surveys.

Regularly holds department meetings and maintains an organized record of agenda and minutes for such department meetings.

Maintains confidentiality of all material that he/she comes in contact with in performing his/her duties and follows all HIPPA regulations.

Report, investigate and respond to all variance reports in the variance software program.

Remains alert for signs of waste, fraud and abuse; immediately reports such findings to the Compliance Hotline.

Fiscal Management:

Develops and demonstrates an understanding of budgetary principles and is accountable for the fiscal management of all department operations.

Monitors budget variances; Initiates corrective action for budget variances.

Monitors and provides accurate timekeeping and submits payroll in a timely manner.

Manages and organizes budget in collaboration with Revenue Cycle Leadership.

Department Specific Obligations:

Develops, implements, supervises and monitors processes related to eligibility and verification of benefits, pre-authorization of services. Makes referrals to Financial Counseling when appropriate.

Provides direct support to the other Pre-Service areas and sets works with team to ensure appropriate expectations regarding verification, pre-authorization, referrals to Financial Counseling when appropriate.

Responsible for the development of new programs to improve the coordination and delivery of financial clearance related activities to ensure ongoing maintenance of efficient and effective operational workflows related to the scheduling and prior authorizations and existing patients.

Demonstrate, through plans and actions, that there is a consistent standard of excellence to which all department work is expected to conform.

Collaborates closely with key stakeholders in Revenue Cycle and the Clinic including direct interaction with physicians and clinic support personnel on all financial reporting matters, operational outcomes and issues to assist with developing and maintain productive working relationships.

Ensures appropriate communication is maintained with physicians, Pre-Service support staff, third party payors, and the patients and their guarantors to assist with optimizing appropriate financial clearance, timely access to care, appropriate billing of services, maximum revenue collection and high customer satisfaction.

Supports the Director of Revenue Cycle in developing financial clearance strategies that support operational improvement, optimization of reimbursement and ongoing enhancement of the patient experience.

Assist the Director of Revenue Cycle with any required education, training, hiring, evaluating and counseling of employees.

Provides assistance with special projects as assigned.

Ensure that the staff members adhere to all organizational standards, are productive, and produce high-quality work.

Understand compliance needs, patient access concerns and overall monitors the patient access functions and completes other duties as assigned while exhibiting exemplary PSMC core customer service values.

Supervise, evaluate and train staff.

Complete patient pre-registration and,

Ensure departmental policies are followed.

Demonstrates excellent customer service skill and effective communication.

Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities and activities may change at any time with or without notice.

Meets the qualifications as set forth herein.