Manager Purchased Referred Care-HHK-Sacaton

Gila River Health Care - Sacaton, AZ

Full-time - Manager

Sacaton, AZ

Hospitals

About the position

The Manager of Purchased Referred Care at Gila River Health Care is responsible for overseeing the daily operations related to healthcare referrals, appointments, and claims processing. This role ensures compliance with health program requirements and Tribal standards while managing a team to achieve organizational goals. The position involves collaboration with various departments and stakeholders to enhance service delivery and staff development.

Responsibilities

• Manage daily administrative and operational activities of appointment and referral and claims processing functions.
• Supervise the review of requests for healthcare referrals based on medical necessity and eligibility criteria.
• Distribute and assign claims to balance workload effectively.
• Collaborate with executives, leadership, and vendors to ensure smooth operations.
• Develop and recommend procedural changes to ensure compliance with standards.
• Meet established objectives and goals in support of Gila River Health Care's mission.
• Provide timely feedback and support to staff for professional growth and performance standards.
• Address patient complaints and escalate issues as necessary.
• Review denials and appeals for payment consideration.
• Audit payment history reports and monitor fund disbursements.
• Participate in departmental training and quality assurance initiatives.
• Foster open communication among staff regarding clinical and administrative matters.
• Act as a resource and coach for staff, identifying growth opportunities.
• Assist in the hiring process and development of disciplinary plans.

Requirements

• Associate's Degree in Healthcare Management, Business, or related field; Bachelor's preferred.
• At least 3 years of healthcare management experience, including 1 year in claims processing.

Benefits

• On-the-job training