Description Regional Manager of Access & Referrals FT Days: AdventHealth Medical Group East FL
Location Address: Palm Coast, FL
Top Reasons To Work At AdventHealth Medical Group East FL
Great team of co-workers that feel like family
The opportunity to Extend the Healing Ministry of Christ
Work Hours/Shift: Full Time, Monday-Friday.
You Will Be Responsible For:
Supports offices in a cost-effective, efficient manner assuring that referral/access staff meets the expectation of delivering high quality services in a courteous and friendly atmosphere.
Oversees the referral and access start-up in new physician practices. This includes newly recruited physicians and established community physicians.
Will coordinate with the assigned Practice Manager/Director to monitor and improve the operations of each practice as it relates to referrals and access; this includes flow management, documentation, training and staffing and provider training and support.
Coordinates in the training of new hires in the practices. Provides feedback to the appropriate Practice Manager/Director as it relates to performance post training on the referral and access processes.
Maintains current job descriptions and completes performance evaluations for each agent position in the department. Ensures competency of staff.
Participates in the preparation of operating budget to include salary and capital budgets. Maintains compliance of those budgets and the productivity standard set for the department(s).
Supervises, schedules, coordinates PDO usage and assigns duties to all employees and ensures department coverage.
Reviews AHS and HCP policies and procedures periodically and makes recommendations to assure continued compliance with current regulations.
Assists in the development and implementation of written policies and procedures that govern the operations of the Practices as it relates to Referrals/Access/Authorizations/Medical Necessity, etc , including but not limited to policies on the patientÃ¢â‚¬â„¢s rights to timely and quality care.
Interprets AHS and HCP policies and procedures to employees, patients, family members, government agencies, etc., as necessary.
Makes routine rounds at the practice level to assure that established referral and access processes are working well for the providers and staff.
Creates and maintains an atmosphere of warmth, personal interest, and position emphasis, as well as a calm environment throughout the Practice.
Proactively evaluates the effectiveness of the service and processes affecting teamwork and makes necessary changes as needed, thereby facilitating effective teamwork with each Practice and the Referral/Access agents.
Communicates to the Director concerning any customer concern.
Acts as Liaison between Referral Agents/Physician and Carrier as needed to facilitate an efficient workflow and ease of access for the patient.
Represents HCP to outside agencies, including governmental agencies and third-party payers, or provides an authorized representative of HCP when unable to attend such meetings.
Ensures that public information describing the services provided is accurate and fully descriptive.
Maintains a good public relations program that serves the best interest of our group practice and the community alike.
Qualifications What You Will Need:
High School graduate
Minimum of five years experience in a healthcare, clinic or physician group practice setting is required.
Minimum of five years experience working with IT Software and Hardware in a healthcare environment.
Knowledge of managed care contracting and insurance plan benefit management including authorization and reimbursement
Driver's License required.
Degree in health or business administration is preferred (AS or BS)
Certified Medical Office Manager Certification preferred (CMOM)
Call Center Certification preferred (CCCM or RCCSP)
Must have knowledge of organization policies, procedures, systems, and objectives and experience in fiscal management and human resource management techniques.
Knowledge of accounting systems, hospital and physician insurance billing and collecting.
Knowledge of Physician Coding/billing requirements and local, state, and federal regulations.
The Regional Manager of Access & Referrals (RAM) works directly with the Operations Director(s) to develop and enhance the training tools and training process used for centralized agents, physicians and all managers and team members involved in the centralized referral and centralized access process. Additionally, aware of the day-to-day functions of AdventHealth Physician Practices and their respective managed care contracted insurance plans to maintain compliance with federal, state, local standards and Adventist Health Systems guidelines and regulations. The RAM is responsible for understanding/carrying out all established policies and processes touching referrals and access at the practice management level including but not limited to software tools including Cerner, PeopleSoft, Cisco Finesse and Athena. Serves as Athena Super User and supports Analytical Analysis of data in support of the operations team.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.