Emory Healthcare
Director, Centralized Precertification
Emory Healthcare, Atlanta, Georgia, United States, 30383
Overview:
Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship,
development,
and leadership programs And more Description:
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:
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.
Process Optimization:
Review and refine pre-certification processes to improve efficiency and accuracy. Implement best practices for tracking and documenting pre-certification requests.
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.
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.
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.
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.
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:
Supporting a diverse, equitable and inclusive culture.
Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.
Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. ACCOMMODATIONS:
EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion. PHYSICAL REQUIREMENTS:
(Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS:
Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.
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Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship,
development,
and leadership programs And more Description:
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:
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.
Process Optimization:
Review and refine pre-certification processes to improve efficiency and accuracy. Implement best practices for tracking and documenting pre-certification requests.
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.
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.
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.
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.
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:
Supporting a diverse, equitable and inclusive culture.
Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.
Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. ACCOMMODATIONS:
EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion. PHYSICAL REQUIREMENTS:
(Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS:
Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.
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