SUPERVISOR, PRIOR AUTHORIZATIONS-MLS, WDL; FULL TIME - 1ST SHIFT

Responsibilities

• Ensures productivity, accuracy, and adherence to policies and payer requirements.
• Oversees end-to-end prior authorization workflows for laboratory testing, including medical necessity review, documentation collection, submission, follow-up, and resolution.
• Serves as an escalation point for complex cases involving providers, payers, and internal stakeholders.
• Collaborates with laboratory leadership, billing, accessioning, and client services to optimize authorization processes and reduce testing delays or denials.
• Communicates effectively with physician offices, hospital systems, and insurance companies to resolve authorization issues and clarify requirements.
• Maintains performance metrics (turnaround time, approval rates, denial trends) and implements process improvements.
• Stays current on payer policies, coverage guidelines, and regulatory requirements impacting laboratory testing.
• Ensures compliance with HIPAA, payer contracts, and internal quality standards.
• Affords assistance with audits, reporting, and root cause analysis related to authorization denials and delays.
• Manages department lab documentation personnel and function.

Qualifications

• A minimum of 4 years of customer service experience in healthcare, specifically working with providers (experience working with insurance companies a plus).
• Laboratory medicine background with understanding of clinical testing workflows and terminology.
• Knowledge of payer authorization requirements, medical necessity guidelines, and documentation standards.
• Proven leadership or supervisory experience in a healthcare operations environment.