Healthcare Services Supervisor

Overview:

The supervisor will also perform duties to support pre-authorization and pre-registration activities, scheduling, and receiving and documenting results and surgical notes for procedures and surgeries performed by Central Health providers at contracted network facilities.

This position will report to the Navigation Center Manager, and will work closely with operations, claims payment, eligibility, medical management, contracting, legal and analytics departments as well as clinical and operations leadership. This position will work at least 50% of their hours on site in the Navigation Center.

Responsibilities:

• Supervises an assigned team of Health Services Coordinators, Health Services Coordination Specialists, and Health Services Coordinator – Leads.
• An estimated 60% of supervisor time is dedicated to performing outgoing calls to patients, providers, imaging/diagnostic centers, sleep study centers, and ambulatory surgery centers to secure appointments for ordered services.
• Supports inbound calls by serving as the supervisor on duty for referral call escalations.
• An estimated 40% of supervisor time is dedicated to direct staff supervision and support, training, preparing and maintaining accurate reporting of assigned staff and work queues, and performing EHR work queue maintenance.
• Supervises outbound referral work queues designated for incoming network specialty consults, diagnostics, imaging, or procedural orders.
• Supervises and assists with routing Outbound Referral Orders received to applicable ASC Work Queues for enhanced Revenue Cycle processing.
• Supervises all activities pertaining to the entirety of the third party procedure or surgery scheduling process, which may include completion of surgical forms, submitting surgical forms via Fax to Central Health Contracted Network Partner Facilities prior to scheduling patient appointment, receiving Inbound results and/or records pertaining to a patient/member’s Diagnostics/Surgery/Procedure, resulting received information into patient/member charts and releasing to provider via Epic.
• Supervises scheduling and referral management activities for incoming referrals for Central Health specialties.
• May assist with development, recommendation, documentation and implementation of changes in support of effective referral management operations.
• Prepares, reviews and interprets reports for referral processes to help determine whether metrics are met, and develops and executes recommendations for necessary improvements.
• Supports the functions and duties of assigned staff.
• Navigates patients within the provider network by working with internal departments and network partners to understand, document and communicate service access and demand.
• Responds to patient inquiries, complaints and request for assistance, and serve as the receiver of escalated calls from staff.
• Attends staff meetings and education offerings both in person and via teleconference/online as required and Supports organizational initiatives to promote and maintain a strong positive workplace culture.
• Successfully meets or exceeds productivity metrics assigned to the position.
• Other duties as assigned.

Qualifications:

Education:

• High School Diploma or equivalent required.
• Associate's Degree or Bachelor's Degree preferred.

Experience:

• 5 years of related experience in a medical or call center setting required.
• 3 years in a supervisory position required.
• Bilingual in English/Spanish - speaking, reading, and writing preferred.

Licenses and Certifications:

• Medical Assistant Diploma and/or Medical Assistant certification preferred.