Supv Referral Management - Remote, United States - MultiCare Health System

Description

You Belong Here.

At MultiCare, we strive to offer a true sense of belonging for all our employees.

Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and flexible schedules.

We are connected by our mission - partnering and healing for a healthy future - and dedicated to the health and well-being of the communities we serve.

GENERAL DESCRIPTION

The Supervisor-Referral Management is responsible for the supervision of system wide referral staff accountable for assuring patient and provider friendly access to MultiCare Health System services and patient care, and accurate completion of referrals and authorizations in compliance with regulatory requirements and MHS policy.

The Supervisor is accountable for the highest levels of quality for all referrals, insurance verification, authorizations, performance levels, and ensuring efficient standards are implemented and maintained; ensures processes and workflows are created and implemented to minimize payment denials and increase patient experience and access to care; trains and develops frontline staff reporting to other managers and interdependent relationships with Patient Access, MMA Clinics, Behavioral Health, Hospitals, and the care management team to ensure accuracy in referral management and appropriate authorizations obtained to secure reimbursement for services across the health system.

to successfully perform their duties to meet department specific and MultiCare goals.

The Supervisor has 24hour/7day responsibility directly supervising staff working at multiple locations and areas to include Referral Management Leadership Team, Business Operation Support Services Team, MMA Clinic Leadership, Access Center, and Receptionists.

In addition, the Supervisor collaborates with other leaders in clinical care departments, Access Center and Pre-service.


PRINCIPAL ACCOUNTABILITIES

• Assures exceptional service to customers, including open channels of communications, prompt response to inquiries and requests, and timely, accurate results to meet provider and patient specifications.
• Assures that the referral/registration/authorization process is done quickly and accurately to facilitate timely initiation of clinical care.
• Oversees and assists with ongoing registration, referral and authorization training and education to decentralized referral management at multiple sites.
• Assures that staff have training in and demonstrate excellent customer service.
• Assures that staff members are skilled in how to calculate co-pays, outstanding deductibles and estimated co-insurance in accordance with MHS policy.
• Assures that staff identify patients who are un/underinsured and refer them for financial counseling as appropriate.
• Participates in the short and long-range planning and quality improvement planning to include its impact on clinical areas and financial management; and participates in the implementation of approved plans.
• Assists Referral Management Leadership in the development and implementation of policies and procedures to assure proper flow of patient information per insurance guidelines and regulatory requirements.
• Assists clinical management in developing policies and procedures to assure proper flow of patient information between patient care areas.
• Coordinates with Medical Providers, Health Information Management and Patient Financial Services to assure the integrity of the medical record is maintained with proper patient information recorded in hospital information system and medical record chart, to include referral and insurance authorization information, procedure codes; diagnosis codes; documenting preparation, correcting accounts, , troubleshooting
• Coordinates with Patient Financial Services, Health Information Management, Information Services, patient care units, outpatient clinics, and labs to assure integrity of patient referrals and authorization for clinical and finance access.
• Oversees dissemination of regulatory and insurance company requirements to all registration and referral/authorization areas for proper claim submission
• Provides Utilization Review to Insurance company RNs
• Provides inpatient and outpatient areas with insurance company requirement for authorizations and referrals for patients to obtain services
• Oversees and assists in the development and maintenance of policy and procedures to properly guide knowledgeable staff.
• Participates in preparation of and monitors actual department budget, identifying any variances and recommends or takes appropriate actions.
• Informs Referral Manager and/or Director of Referrals and Capacity of the status of projects and operations.
• Participates with other Referral Supervisors as part of a management team, working with the Referral Manager(s) and Director of Referrals and Capacity to continuously improve access services at MHS.
• Maintains current competency in referral and authorization management concepts by participating in relevant professional associations such as NAHAM.
• Supervises staff, providing direction and guidance; and administers Human Resource functions within the provisions of MultiCare policies and standards.
• Assumes administrative on-call assignments evenings, holidays, and weekends as necessary.
• Adheres to MHS Attendance and Punctuality Policy and Procedure standards and maintains reliable attendance.
• Contributes to the success of the organization by meeting organizational competency expectations and core values (respect, integrity, stewardship, excellence, collaboration, and kindness), continuously learning, and by performing other duties as needed or assigned.

LEADERSHIP COMPETENCIES
Personal Competencies

• Integrity
• Accountability
• Self-Development

Interpersonal Competencies

• Communication
• Collaboration
• Fostering Teamwork
• Developing Others

Organizational Competencies

• Customer Focus
• Quality and Strategic Focus
• Financial and Operational Management

MINIMUM QUALIFICATIONS
KNOWLEDGE, SKILLS, & ABILITIES

• Knowledge and understanding of the regulations governing access to services, referrals, authorizations and health information, payer requirements and contracts.
• Ability to coordinate and delegate workloads.
• Ability to demonstrate strong organization and problem-solving skills.
• Ability to provide leadership skills to a team in a fast-paced challenging environment.
• Ability to models and cultivate staff behaviors that achieve business success, including leadership skills, collaboration, accountability, and ownership.
• Ability to work effectively with a wide range of internal and external contacts such as other Patient Financial Service divisions, Access Centers, Information Services, Medical Records, patient care departments, patients, families, insurance companies, Dept. of Social and Health Services, Center for Vital Statistics, and other agencies.
• Extensive knowledge of managed care programs and MHS contractual agreements
• Extensive knowledge of referral management and authorizations
• Extensive knowledge and proficiency of medical terminology
• Knowledge of current regulations regarding proper consent for treatment, availability of uncompensated care, surgical consents, and advance directives
• Knowledge of the principals of Information Management to effectively analyze and make decisions.
• Knowledge of organizational and department procedure and established confidentiality policies
• Ability to communicate effectively.
• Ability to work efficiently under pressure.
• Ability to work independently and take initiative.
• Ability to willingly accept responsibility.
• Ability to set priorities and use good judgment.

EDUCATION & EXPERIENCE

• Bachelor's degree required.
• Five (5) years of experience in Access Services, Pre-Service, Referral Management, Scheduling, Prior Authorizations, and/or Registration required.
• Three (3) year supervisory and/or lead and/or training experience.
• Consideration may be given to internal candidates not meeting the minimum qualifications.

Job descriptions represent a general outline of job duties, functions, and qualifications. They are not intended to be comprehensive in nature.

In addition, jobs evolve over time and therefore their description may not reflect the precise nature of the position at a given point in time.

It is MultiCare's policy to base hiring decisions solely on the individual's ability to perform essential job functions. Persons with disabilities are eligible for this position provided they can perform those functions with reasonable accommodation.

Original Approval:
Jamie Jackson-Rogers August 2021 Manager Referral Management


FTE:
1.0, Shift: Days, Schedule: Variable

Position Summary

The Supervisor-Referral Management is responsible for the supervision of staff accountable for assuring patient and provider friendly access to MultiCare Health System services and patient care, and for accurate completion of referrals and authorizations in compliance with regulatory requirements and MHS policy.

The Supervisor is accountable for the highest levels of quality for all referrals, insurance verification, authorizations, performance levels, and ensuring efficient standards are implemented and maintained; ensures processes and workflows are created and implemented to minimize payment denials and increase patient experience and access to care; trains and develops frontline staff reporting to other managers and interdependent relationships with Patient Access, MMA Clinics, Behavioral Health, Hospitals and the care management team to ensure accuracy in referral management and appropriate authorizations obtained to secure reimbursement for services across the health system.

The Supervisor has 24hour/7day responsibility directly supervising staff working at multiple locations and areas to include Referral Management Leadership Team, Myriadd Team, MMA Clinic Leadership, Access Center and Receptionists.

In addition, the Supervisor collaborates with other leaders in clinical care departments, Access Center and Pre-service.

Requirements

• Associate degree preferred, two (2) years of leadership experience will be considered in lieu of the degree
• Two (2) years of experience in Access Services, Pre-Service, Referral Management or Revenue Cycle field required
• Previous experience and demonstrated skills in a leadership or a supervisor role
• One (1) year supervisory or lead experience preferred
• Internal candidates will be considered if minimum qualifications are not met

Our Values

As a MultiCare employee, we'll rely on you to reflect our core values of Respect, Integrity, Stewardship, Excellence, Collaboration and Kindness.

Our values serve as our guiding principles and impact every aspect of our organization, including how we provide patient care and what we expect from each other.

Why MultiCare?

• Belonging: We work to create a true sense of belonging for all our caregivers
• Mission-driven: We are dedicated to our mission of partnering for healing and a healthy future and the patients and communities we serve
• Market leadership: Washington state's largest community-based, locally governed health system
• Employee-centric: Named Forbes "America's Best Employers by State" in 2023
• Technology: "Most Wired" health care system 15 years in a row
• Leading research: MultiCare Institute for Research & Innovation, 40 years of ground-breaking, clinical and health services research in our communities
• Lifestyle: Live and work in the Pacific Northwest - offering breathtaking water, mountains and forest at every turn

Pay and Benefit Expectations

We provide a comprehensive benefits package, including competitive salary, medical, dental and retirement benefits and paid time off.

As required by various pay transparency laws, we share a competitive range of compensation for candidates hired into each position.

The pay scale is $70, $102,128.00 USD.

However, pay is influenced by factors specific to applicants, including but not limited to:
skill set, level of experience, and certification(s) and/or education.

If this position is associated with a union contract, pay will be reflective of the appropriate step on the pay scale to which the applicant's years of experience align.

Associated benefit information can be viewed here.