TMS Health Partners

  • Prior Authorizations Manager (TMS Specialist and Reimbursement Manager)

    Job Locations US-CA-SAN FRANCISCO | US-CA-Sacramento
    Job ID 2019-1053
    # of Openings
    1
    Category
    Prior Authorizations
  • Overview

    TMS Specialist & Reimbursement Manager

    Under the supervision of COO you will lead the TMS Specialist, Reimbursement and Care Advocates to ensure program optimization. To succeed, you will need to be a master of organization with strong leadership skills. Your drive to exceed performance expectations will contribute to an efficient revenue cycle department as well as optimal TMS Clinic operations overall.

    Responsibilities

    ROLES AND RESPONSIBILITIES

    • Lead and manage TMS Specialist & Reimbursement Advocates training/onboarding, performance, and program optimization.
    • Ensure appeal efficiency, TMS lead conversions, communication of payor policy updates, and procedural internal auditing. As well as refining any workflow processes as needed.
    • Participate in TMS practice development under the direction of Medical Leadership. Specifically, in TMS education, Marketing campaigns, and TMS Connect program facilitation and management.
    • Ensure and maintain positive external partnerships and payor relations.
    • Conduct TMS trainings for new and existing providers.
    • Collaboratively work with clinic operations leadership team to work towards co-leadership of the TMS Specialist, Reimbursement and Care Advocate team.
    • Partner with Medical Leadership to weave Depression Care Pathway into the fabric of the clinic culture, including but not limited to, leveraging DCP report in proactive communication with providers.
    • Create template and workflows to initiate and complete patient authorizations. Ensure each referral follows the process, from taking the initial referral until final disposition, acceptance or denial. Present metrics for further improvement and evaluation.
    • Obtain timely authorization of all patients requiring pre-certification and maintain accountability for conversion percentage and results.
    • Ensure all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
    • Encourage and model teamwork, communication and collaboration with other departments to include, but not limited to, a smooth and effective hand off patients to Case Management to ensure continuity in patient care plan.
    • Produce learning materials and articulate key concepts in a consistent clear manner.
    • Work collaboratively with different quality care initiatives such as Clinical Decision Support, Medical Leadership, system performance and other consultants and staff.
    • Participate and collaborate in TMS case conferences.
    • Perform other duties as needed by your supervisor.

    Qualifications

    QUALIFICATIONS:

    • Bachelor’s degree, or equivalent experience required
    • At least 3 years of case management working with insurance companies to obtain prior authorization medical services required
    • Minimum of 2 years’ experience in overseeing/managing a small team
    • Proven track record in training others in the medical field is essential
    • Exceptional customer service skills required.
    • Excellent oral and written communication skills. Must be comfortable interacting with all levels within and outside the organization.
    • Proficiency in working with Electronic Health Record system required; NexGen experience a plus.
    • Action focused and proven ability to thrive in a startup and rapidly growing and changing business required

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