Director, Centralized Precertification at Emory Healthcare

Atlanta, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Mar, 26

Salary

0.0

Posted On

13 Dec, 25

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Healthcare Administration, Pre-certification, Utilization Management, Insurance Verification, Regulatory Compliance, Data Analysis, Problem-solving, Communication, Interpersonal Skills, Team Management, Training Development, Operational Efficiency, Process Optimization, Collaboration, Mentorship

Industry

Hospitals and Health Care

Description

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 Overview: 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.

Responsibilities

The Director of Pre-Certification will oversee the pre-certification process, ensuring compliance with regulatory and insurance requirements. This role involves leading a team, optimizing processes, and collaborating with clinical staff and insurance providers.