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The Director of Pre-Certification will oversee the pre-certification process within Emory Healthcare, ensuring that all medical services, procedures, and treatments meet regulatory and insurance requirements before they are delivered. This leadership role requires a strategic thinker with a deep understanding of healthcare regulations, insurance practices, and operational efficiencies. The Director will lead a team of pre-certification specialists, collaborate with clinical staff, and engage with insurance providers to enhance patient care and streamline operational processes.
Key Responsibilities:
1. Leadership and Management:
Lead, mentor, and develop a high-performing team of pre-certification specialists. Establish performance metrics and ensure the team meets operational goals and compliance standards.2. Process Optimization:
Review and refine pre-certification processes to improve efficiency and accuracy. Implement best practices for tracking and documenting pre-certification requests.3. Collaboration and Communication:
Work closely with clinical teams to understand service needs and facilitate timely pre-certifications. Act as a liaison between the organization and insurance providers to resolve issues and enhance communication.4. Compliance and Regulatory Oversight:
Ensure compliance with all federal, state, and local regulations regarding pre-certification. Stay updated on changes in healthcare laws and insurance policies that may impact pre-certification processes.5. Data Analysis and Reporting:
Analyze pre-certification data to identify trends, challenges, and opportunities for improvement. Prepare and present reports to senior management on pre-certification metrics and departmental performance.6. Training and Development:
Develop and deliver training programs for staff to enhance their understanding of pre-certification processes and insurance requirements. Foster a culture of continuous improvement and professional growth within the team.
Minimum Qualifications:
Education:
Bachelors degree in Healthcare Administration, Nursing, or a related field; Masters degree preferred.Experience:
Minimum of 10 years of experience in healthcare administration or a related field, with at least 5 years in a leadership role focused on pre-certification or utilization management. Extensive knowledge of insurance verification and healthcare regulations.Skills:
Strong analytical and problem-solving abilities. Excellent communication and interpersonal skills. Proven leadership and team management capabilities. Proficiency in healthcare management software and data analysis tools.Additional Details
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.
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