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Overview

Be inspired** **.** **Be rewarded. Belong. At Emory Healthcare.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoingmentorshipand leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

+ Comprehensive health benefits that start day 1

+ Student Loan Repayment Assistance & Reimbursement Programs

+ Family-focused benefits

+ Wellness incentives

+ Ongoing mentorship, _development,_ and leadership programs

+ And more

Description

Overview:

The Director of Pre-Certification will oversee the pre-certification process within Emory Healthcare, ensuring that all medical services, procedures, and treatments meet regulatory and insurance requirements before they are delivered. This leadership role requires a strategic thinker with a deep understanding of healthcare regulations, insurance practices, and operational efficiencies. The Director will lead a team of pre-certification specialists, collaborate with clinical staff, and engage with insurance providers to enhance patient care and streamline operational processes.

Key Responsibilities:

1. Leadership and Management:

+ Lead, mentor, and develop a high-performing team of pre-certification specialists.

+ Establish performance metrics and ensure the team meets operational goals and compliance standards.

2. Process Optimization:

+ Review and refine pre-certification processes to improve efficiency and accuracy.

+ Implement best practices for tracking and documenting pre-certification requests.

3. Collaboration and Communication:

+ Work closely with clinical teams to understand service needs and facilitate timely pre-certifications.

+ Act as a liaison between the organization and insurance providers to resolve issues and enhance communication.

4. Compliance and Regulatory Oversight:

+ Ensure compliance with all federal, state, and local regulations regarding pre-certification.

+ Stay updated on changes in healthcare laws and insurance policies that may impact pre-certification processes.

5. Data Analysis and Reporting:

+ Analyze pre-certification data to identify trends, challenges, and opportunities for improvement.

+ Prepare and present reports to senior management on pre-certification metrics and departmental performance.

6. Training and Development:

+ Develop and deliver training programs for staff to enhance their understanding of pre-certification processes and insurance requirements.

+ Foster a culture of continuous improvement and professional growth within the team.

Minimum Qualifications:

Education:

+ Bachelors degree in Healthcare Administration, Nursing, or a related field; Masters degree preferred.

Experience:

+ Minimum of 10 years of experience in healthcare administration or a related field, with at least 5 years in a leadership role focused on pre-certification or utilization management.

+ Extensive knowledge of insurance verification and healthcare regulations.

Skills:

+ Strong analytical and problem-solving abilities.

+ Excellent communication and interpersonal skills.

+ Proven leadership and team management capabilities.

+ Proficiency in healthcare management software and data analysis tools.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at [email protected] . Please note that one week's advance notice is preferred.

Connect With Us!

Connect with us for general consideration!

**Division** _Emory Healthcare Inc._

**Campus Location** _Atlanta, GA, 30306_

**Campus Location** _US-GA-Atlanta_

**Department** _EHI Precert_

**Job Type** _Regular Full-Time_

**Job Number** _157890_

**Job Category** _Business Operations_

**Schedule** _8:30a-5p_

**Standard Hours** _40 Hours_

**Hourly Minimum** _USD $0.00/Hr._

**Hourly Midpoint** _USD $0.00/Hr._

Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.