Associate Director, Rev Cycle - Prior Authorization

POSITION SUMMARY:

The Associate Director, Prior Authorizations will effectively lead the Prior Authorization teams while maintaining a full understanding of Natera’s billing information system and all aspects of revenue cycle management. The Associate Director manages the activities of the billing staff through daily supervision while overseeing all Prior Authorization Billing, Pre-certification and Eligibility functions. The Associate Director executes and implements strategic goals for through the utilization of their leadership team. The Associate Director leads individuals who direct and plan daily workflow activities for billing staff members. The Associate Director functions as a member of the leadership team in strategic planning and advisory capacities.

PRIMARY RESPONSIBILITIES:

• Directs Billing Management and staff to ensure that authorizations, accurate submission of all claims and timely collections occurs in accordance with all third-party contract terms including, Medicare, Medical, managed care, commercial insurance, and direct patient pay.
  
  
• Establishes and maintains all billing and financial data, including medical billing code tables, rate schedules and payer information.
  
  
• Analyzes reimbursement from all sources, including carrier reimbursement exception reporting and follow up pending claims analysis and denials management.
  
  
• Assures maximization of cash collections through diligent and timely monitoring of all authorizations and open accounts receivable balances.
  
  
• Maintains and enhances billing policies and procedures for each function in the revenue cycle process and ensures staff adherence to policies.
  
  
• Prepares detailed analyses and reports of prior authorizations, billing, accounts receivable activity and results, including performance matrixes, bad debt expense and AR days outstanding.
  
  
• Manages for continuous improvements within the prior authorizations and revenue cycle process.
  
  
• Effectively interacts with various functional areas and provides mentoring, coaching and performance reviews for direct reports.
  
  
• Manages all outreach billing operations, including hiring, orientation, training, development, coaching, corrective actions, and ongoing monitoring of all staff work-related activities.
  
  
• Ensures consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department’s productivity.
  
  
• Leads a high performance team responsible for Prior Authorization Billing Operations.
  
  
• Provides leadership, drives change, and facilitates process improvements.
  
  
• Actively collaborates with the RCM (Billing) Finance team on analysis of billing activity for monthly financial reporting, the sales and marketing team of new and existing clients, and senior management on performance and new initiatives.
  
  
• Participates in the Compliance Committee for Coding and Billing related items; establishes and enforces departmental and company policies and procedures.
  
  
• Develops and monitors operating procedures and, where necessary, implements changes in workflow to improve productivity.
  
  
• Drafts accurate budgeting and forecasting of headcount and cash receipts.
  
  
• Creates and holds billing leadership accountable for established performance and production standards. Maintains billing related quality patient outcomes
  
  
• Conducts annual performance evaluations, makes hiring decisions, and develops corrective action plans when necessary.
  
  
• Interfaces with third party payers to resolve reimbursement issues and provides guidance to appropriate senior leadership regarding contracting challenges.
  
  
• Provides direction to and development of associates through daily coaching, the administration of performance management, and the creation and implementation of development plans.
  
  
• Assesses performance and provides timely and constructive feedback to staff. Determines additional training needs.
  
  
• Prepares annual performance evaluations and recommends merit increase and bonus percentages. Promotes organizational efficiency, needed change and continuous quality improvement.
  
  
• Identifies and implements opportunities for automation and improved efficiency.
  
  
• Assists as needed to perform other related duties and special projects as required.
  
  
• This role works with PHI on a regular basis both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) in order to perform the job
  
  
• Employee must complete training relating to HIPAA/PHI privacy, General Policies and Procedure Compliance training and security training as soon as possible but not later than the first 30 days of hire.
  
  
• Must maintain a current status on Natera training requirements.
  
  

QUALIFICATIONS:

• Bachelor’s Degree in related field or equivalent years of relevant experience required
  
  
• Minimum of 8 years of experience in managing a high volume, fast growing billing office within the laboratory setting is preferred.
  
  
• Extensive Prior Authorization billing operations experience
  
  
• Extensive knowledge of reimbursement, billing, coding and compliance regulations is required.
  
  
• Experience with data analysis, reporting and relevant tools, such as Excel and PowerBI is required. 

KNOWLEDGE, SKILLS, AND ABILITIES:

• Demonstrated leadership ability in a multi-site environment.
  
  
• Capacity to actively engage and communicate with a wide variety of employees, senior leaders and external auditors to drive change and problem solve.
  
  
• Ability to respond to change quickly and generate creative ideas and solutions to emerging business changes.
  
  
• Active, visible and influential leadership style such as ability to directly engage, arrive at conclusions, drive consensus, and monitor actions in support of quality outcomes.
  
  
• Skilled in researching, interpreting, and presenting data in a concise manner.
  
  
• Demonstrates strong ability to effectively plan, organize, and delegate.
  
  
• Leads by example and demonstrates commitment to continual improvement and a passion for excellence.
  
  
• Maintains a high standard of discipline, professionalism, and sound decision making for excellence. Ability to motivate a highly successful team to exceed performance goals, drive change, and lead a growing staff.
  
  
• Personable, persuasive, and comfortable navigating all levels of the workforce.
  
  
• Communication – Proficient verbal and written communication skills.
  
  
• Willingness to share and receive information and ideas from all levels of the organization in order to achieve the desired results.
  
  
• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team.