Deputy Director- Authorizations and Referrals (1035)

About the role

Under the general direction of the Executive Director of Revenue Cycle, the incumbent provides strategic and operational leadership for authorization and referral functions across SIU Health Care. The position is responsible for ensuring timely and accurate prior authorization, referral, and related payer requirements for scheduled and unscheduled services; developing standardized workflows; monitoring productivity, quality, denials, and financial outcomes; and partnering with clinical departments, payers, and other Revenue Cycle teams to reduce administrative burden and prevent avoidable delays in patient care. This position oversees assigned authorization and referral staff and leaders, supports system and process optimization, and serves as a representative of the Executive Director as requested. *This position is ON SITE only*

Responsibilities

• 95% Responsibility for the leadership, hiring, development, performance management, and evaluation of staff and leaders within the Authorization and Referral functions. Assigned responsibilities and duties may be delegated to subordinate staff.
• Develop, implement, and monitor staffing plans, productivity expectations, and resource needs necessary to carry out the responsibilities of the Authorization and Referral functions.
• Monitor workload, service demand, and operational performance and prepare recommendations for additional staff, technology, or resources when appropriate.
• Develop, implement, standardize, and maintain authorization and referral workflows, work queues, payer requirements, documentation standards, and escalation processes to support timely patient access, accurate authorization determinations, and efficient Revenue Cycle operations.
• Establish and maintain effective working relationships with government and commercial payers to clarify authorization, notification, referral, medical necessity, and benefit requirements.
• Escalate payer-related barriers and recurring issues and partner with Managed Care and other appropriate departments on resolution.
• Oversee the timely initiation, submission, follow-up, and documentation of prior authorization and referral requests for services.
• Ensure required clinical and administrative information is obtained and submitted in accordance with payer requirements and organizational standards.
• Develop and monitor processes for authorization and referral denials, peer-to-peer requests, appeals, retroauthorizations, and other escalations.
• Partner with clinical teams, Coding, Patient Financial Services, Managed Care, and other Revenue Cycle areas to identify root causes and reduce preventable denials and write-offs.
• Prepare and monitor production, quality, turnaround-time, denial, financial, and other performance reports.
• Analyze trends, document decision rationale, identify opportunities for improvement, and provide recommendations to Revenue Cycle leadership and operational partners.
• Work with Information Technology, Epic, and operational stakeholders to identify, develop, test, implement, and optimize automated systems, work queues, decision support, payer content, and processes that improve the effectiveness and efficiency of authorization and referral operations.
• Develop, implement, monitor, and continuously improve policies, procedures, controls, and performance standards for effective authorization and referral management, including processes that support appropriate scheduling, patient communication, and financial clearance.
• Troubleshoot complex authorization and referral issues and provide guidance to faculty, clinical staff, operational leaders, and Revenue Cycle staff.
• Research escalated inquiries, identify appropriate resources, and develop solutions for issues that may affect patient access, reimbursement, or operational performance.
• Develop and maintain positive communication and collaborative relationships with clinical departments, scheduling and access teams, Revenue Cycle departments, Managed Care, Information Technology, School of Medicine administrators, and other internal and external partners.
• Monitor compliance with organizational policies, payer requirements, regulatory standards, and established authorization and referral procedures.
• Promote accurate and consistent practices that support patient access, compliance, and appropriate reimbursement.
• Represent Authorization and Referral operations on internal and external committees, workgroups, payer meetings, system implementation teams, and other groups as assigned.
• Attend seminars, workshops, and other continuing education activities related to prior authorization, referrals, payer requirements, patient access, reimbursement, regulatory changes, and Revenue Cycle operations.
• Functions as a representative of the Executive Director of Revenue Cycle during his/her absence and/or as delegated.
• 5% Performs other duties as required or assigned which are reasonably within the scope of the duties described above.

Qualifications

Minimum Qualifications: Eleven (11) years of progressively responsible management work experience in a private or governmental organization: Eight (8) years in the area of