Dana-Farber Cancer Institute Sr Referrals and Authorizations Manager in Brookline, Massachusetts

The Senior Referrals and Authorizations Manager of Access Management, oversees and assumes responsibility and accountability for the day-to-day operations of obtaining referrals and third party payer authorizations. The Sr. Manager oversees and participates in Epic related activities incorporated within and/or bridge across Access Management, ensuring appropriate DFCI participation, support, and escalation. He/she ensures that appropriate regulatory requirements are met. The Sr. Manager tracks and trends performance and productivity of staff, identifying quality and productivity enhancement projects that align with departmental and Institute goals. The Sr. Manager is directly involved in implementing new initiatives and performs high-level project scoping, planning, testing, implementation and monitoring. The Sr. Manager provides ongoing training and education and assumes responsibility for staffing, problem solving, and leading by example. He/she participates in preparing the department annual budget and performance goals.

  • Direct management responsibility of patient referral and authorization functions, PCP referrals, drug authorizations, radiology authorizations, molecular pathology authorizations.

  • Ensures appropriate communications and hand-offs to other Institute departments, including those aligned with upstream and downstream activities.

  • Fluent in Epic and Epic-aligned department tools / systems, ensuring pursuit of efficiencies and best practices, appropriately participating in the governance and change processes.

  • Develops team-specific goals which align with the Access Management department’s goals and the Institute's overarching principles and goals.

  • Reviews team-specific workflows with Managers, Supervisors and Coordinators to confirm business objectives are met, assumptions are accurate, limitations are minimized, and enhancement opportunities are identified.

  • Responsible for ensuring patient referral and authorization requirements minimizing the Institutes financial risk on an average monthly net revenue of $77M.

  • Leads quality improvement projects focused on improving customer satisfaction, staff satisfaction, and achieving departmental performance goals.

  • Resolves escalated team and department issues by collaborating with appropriate internal and external point persons to initiate and orchestrate valued change.

  • Conducts regular team meetings for purposes of education, updates and feedback inquiries.

  • Assist in planning and co-chairs the quarterly, department-wide staff meetings and proactively offers to prepare and conduct innovative educational update sessions for the group.

  • Document work items in progress, final workflows and appropriate policies and procedures.

  • Works collaborate with Clinical Providers, Clinical Support Managers, Directors, Administrators and Senior Leadership within the Institute as well as outside business partners including PeC, BWH, CHB, third party payers and vendors.

  • Assists with planning and implementing new initiatives.

  • Ensures new and established staff complete Epic required training and participate in refresher and skill enhancement training as needed.

  • Monitors staffing resources and ensures adequate coverage for required duties. Establishes work priorities and staff assignments.

  • Completes staff performance reviews in accordance with Institute's policies and productivity metrics.

  • Steward of DFCI culture

  • Performs other duties as assigned.

SUPERVISORY RESPONSIBILITIES:

Responsible for supervision of 24 permanent staff with 3-5 direct reports.

Bachelors degree required, Masters degree preferred with a minimum of 8 years experience in revenue cycle operations or related field. Prior managerial experience required. Knowledge of Government sponsored, Commercial and Third Party Liability Medical Insurance, hospital and/or physician registration operations. Knowledge of patient registration/scheduling systems and related applications required – Epic, NEHEN, Zirmed systems experience preferred.

Job ID: 2017-7556

External Company Name: Dana-Farber Cancer Institute

External Company URL: www.dana-farber.org