Authorization Supervisor

Supervises and Coordinates

Supervises day to day departmental operations and processes of the pre-certification department.

Provides guidance, support and direction to the department and staff.

Assists staff with the understanding and implementation of policies and procedures to increase the overall efficiency of the department.

Monitors and Oversees

• Ensures quantity of diagnostic and surgical procedures is efficient for precertification.
• Works with associates in complex pre-certification cases, ensuring protocols are followed and reimbursements are maximized.
• Works with payers to resolve technical problems and educate the team on changes affecting reimbursement and precerts.
• Collaborates with medical providers to evaluate medical procedures for necessity, appropriateness, and efficiency.

Works with Team

• Coordinates documentation submitted by medical providers to assess medical necessity and payment for services.
• Establishes relationships with physicians, office staff, patients, and healthcare team members.
• Schedules work ensuring adequate staffing based on workload and productivity standards.

Maintains and Develops Workforce

• Hires, evaluates performance, counsels, trains, issues corrective action, recommends promotions or discharges of department personnel.
• Develops and implements processes through orientation, training, and education to ensure staff competence.
• Participates in the preparation of capital budgets and monitors expenditures within budget limits.

Physical Demands

• Exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• Close visual acuity for preparing and analyzing data and figures, transcribing, viewing a computer terminal, and extensive reading.
• Light work - light physical demands.

Education and Experience

• Required: Technical Degree or Diploma in Nursing.
• Required: 5-7 years Authorization or Denials Management, Clinical Nursing, Precertification, and Case Management experience.
• PREFERRED: 5-7 years Case Management, Lead, Supervisory, or Management experience.

Knowledge, Skills and Abilities

• Proficient in Microsoft Office such as Word and Excel.
• Extensive knowledge in insurance coverage practices, terminology, and requirements for referrals and authorization/pre-certification.
• Experience working with pre-certification and/or CPT medical codes.
• Demonstrated analytical ability to collect and interpret insurance and contract information.
• Uses clinical knowledge to effectively manage pre-certifications for complex surgical and invasive procedures.
• Experience with PPO and Managed Care insurance.
• Strong attention to detail and critical thinking skills.
• Ability to make decisions based on clinical knowledge/practices.
• Experience with a computerized healthcare information system.
• Familiarity with fundamental Microsoft word software.
• Excellent verbal and written communication skills.
• Demonstrates leadership abilities, judgment, and supervisory skills in organizing work, assigning staff, and making exceptions to policy.