Pre-Service Supervisor - USA Health : Job Details

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Oversees Pre-Service processes and supervises staff; helps guarantee reimbursement by verifying insurance eligibility and benefits, confirming medical necessity and ensuring prior approvals are in place and maintained for the duration of service; utilizes various resources to obtain insurance policy information including referral source, insurance provider, patient, physicians and practitioners; supervises employees including hiring, disciplinary action and evaluations; ensures appropriate orientation is provided for all newly hired staff; monitors quality and productivity on a continuing basis and recommends improvements to management as needed; manages inbound inquiries regarding services provided, financial responsibility and insurance coverage; monitors and maintains a fiscally sound, well organized and productive department; verifies coverage and benefits and document in appropriate systems; ensures medical necessity of prescribed services, insurance coverage and adequate financial resources; obtains prior approval when required by carrier; maintains active authorization for duration of care; informs financial counselors and social workers when patient is uninsured or underinsured; reviews clinical documentation for additional diagnosis when recorded code doesnt meet criteria for coverage; collaborates and validates findings with a certified coder and documents in EMR; notifies physician team of correction or lack of medical necessity if qualifying diagnosis cannot be identified; updates EMR with additional codes when discovered; prepares patient benefit and financial estimate and forwards to Financial Counselors; stays abreast of insurance carrier acceptance and coverage policies to include referral requirements and non-covered services waiver; utilizes customer relations skills and always communicates professionally to establish and maintain positive relationships with all customers, internal and external; accepts and completes all duties positively and without conflict. Cooperates, helps and improves the performance of the unit; regular and prompt attendance; ability to work schedule as defined and overtime as required; related duties as required.

Associates degree in healthcare administration, nursing or related field and five years of experience in an oncology setting, two of which were in a managerial/supervisory capacity. Directly related experience can substitute on a year-for-year basis for the required education.