Enterprise Director Authorization Services - Remote Eligible

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Directs patient pre-certification processes performed in the WVU Medicine Centralized Authorization team servicing all WVUHS hospital facilities. Responsible for the accuracy and consistency of hospital pre-certification and insurance verification for the health system. Develops and controls all tasks necessary to ensure all activities are completed on-time, including building relationships with internal and external clients throughout WVU Medicine. Utilizes internal resources and analytical skills to make decisions in fast-paced, fluid environment. Accountable for making strategic decisions guided by organizational issues, trends, and business implications, keeping in mind that decision may have regional/local implications. Recognizes cross-function interdependencies of decision. May challenge decisions where precedents have been set and communicates rationale with stakeholders to gain consensus. Supports the success of a high-performing patient financial access department by helping to champion and drive long term success, achieving results comparable to national best practices. Achieves highest standard of customer service while maintaining consistency and representing the WVU Medicine brand to our patients.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

Bachelor's Degree within 90 days of hire

OR

4 years relevant experience

EXPERIENCE:

1. 5 years management experience required

2. 5 years of experience inpatient financial access services including registration, scheduling, pre-certification, and/or financial counseling.

PREFERRED QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's Degree in Accounting, Finance, or Business

2. Master's Degree, CPA, Certified Healthcare Financial Professional (CHFP) of HFMA

EXPERIENCE:

1. Experience developing standards, processes, policies and procedures for a diverse organization

2. Record of success managing complex projects with multiple, diverse stakeholders.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Directs Scheduling and Order Management Functions : Leads efficient local scheduling and order entry functions throughout the WVU Medicine Hospitals. System Director will establish standard processes and procedures where possible to streamline functions for the system entities. Work with WVU Medicine Information Technology to ensure efficient and effective workflows. Continually monitor productivity and quality through standard processes and scorecards.

2. Directs Pre-Certification Functions: Workflows for pre-certification varies throughout the health system. Enterprise Director will establish standard processes and procedures where possible to streamline functions for the system entities. Will work closely with information technology team for appropriate EPIC modules (Optime, Cupid, Cadence, etc.) to aid in the design of efficient and effective workflows. Monitors processes for failures and continually refines to ensure staff is supported and productivity and quality standards are met. Work closely with Directors in Patient Financial Services and Patient Access to communicate and solve any denial issues arising due to these functions. Continually monitor productivity and quality through standard processes and scorecards. Acts as the primary resource for implementation of automations that assist staff productivity and accuracy.

3. Guides Departmental Goals and Achievement: Functions as primary resource for all Patient Financial Access decisions related to pre-service clearance with information technology, patient financial services, medical records, utilization management, ancillary revenue departments, etc. for the West Virginia University Health System. Ensures close cooperation, planning and strategic alliances with all areas affecting patient financial outcomes. Plans and sets goals with all related areas to ensure decisions are optimal for organizational goals and consistent with missions, administrative philosophy and guidelines. Ensures physician relationships are developed and maintained to reflect collaborative environments. Adheres to and ensures all compliance requirements are met or exceeded with the highest standards of integrity.

4. Serves as Representative of Department and Team Within the Organization: Integrates department operations into clinical hospital operations where needed. Adheres to all hospital policies and procedures through sound management practices. Ensures employee evaluations are objective, address employee performance, and timely. Provides direction and serves as a resource for employees to facilitate future growth. Continually assesses hospital needs and ensures that staff qualifications meet hospital needs. Prepares and administers annual operating and capital budgets for department reporting variances where required.

5. Adheres to the established Performance Expectations for WVUHS Employees in the areas of People, Service, Performance Improvement, Shared Values, and Culture.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office work which includes sitting for extended periods of time

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office work which includes sitting for extended periods of time

2. Travel to all hospital sites required

SKILLS AND ABILITIES:

1. Must have strong oral, written and analytical abilities.

2. Must be able to supervise personnel to effectively represent the department and hospital in interactions with payers, patients, physicians and other departments.

3. Must also have ability to perform a variety of duties, ranging from direct involvement in various procedures to coordination of activities of many subordinates.

4. Experience with Microsoft Office required.

5. Experience with EPIC or similar system preferred.

6. Experience managing complex/ large scale/ transformational projects, including demonstrated success in coordinating major projects.

7. Experience developing standards, processes, policies, procedures and service level agreements.

8. Demonstrates leadership in planning new or expanded services, managing projects and coordinating multi-department task forces.

9. Understanding and experience with performance metrics.

10. Ability to establish, develop and manage collaborative professional relationships.

11. Experience developing and managing department budgets.

12. Aptitude to conceptualize, plan, and implement stated goals and objectives.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

536 SYSTEM Hospital Authorization Unit