Insurance Authorization Manager
Insurance Authorization Manager
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Job Description
Overview
Pursue your passion and fulfill your purpose at KidsCare! KidsCare Home Health is a multiawardwinning organization who was most recently recognized as a2024 U.S. Top Workplace. As an awardwinning organization we are looking for dedicated professionals who will embrace the KidsCare core values. At KidsCare we desire to work with individuals who embody the values of the organization which together create our C.A.R.E. culture.In return we offer afull benefits package to include health dental and vision insurance paid time off 401K tuition reimbursement and a hybrid or blended work arrangement (providing balance between in office and work from home).
Responsibilities
The Insurance Authorization Manager oversees the daily operations and performance of insurance authorization activities. The position provides guidance coaching and support for optimal employee success and has on going knowledge of each states policies and procedures works with multiple payer sources and obtains insurance authorization for physician ordered services. The position is also responsible for monitoring and recertifying patient insurance authorization prior to the current expiration date.
Essential Duties and Responsibilities
- Maintain a current knowledge base related to insurance requirements for authorization. Serve as a knowledgeable resource on authorization requirements.
- Monitor and track key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.
- Run departmental reports such as but not limited to recert due report outstanding completed visits denial/kickback report and auth expiry as needed daily/monthly/quarterly.
- Evaluate and recommend changes to optimize workflows to achieve successful operational and quality outcomes and benefit maximization within the scope of responsibilities.
- Provide oversight support and direction to employees according to the teams procedures and timelines.
- Provide effective performance feedback through performance reviews rounding employee recognition and disciplinary actions.
- Manage the preparation of and conduct routine team meetings to provide company or department changes/updates.
- Maintain payer requirements on an ongoing basis
- Maintain professional relations with internal/external associates.
- Maintain employee work schedules including job rotations training paid time off and overtime via ADP. Ensure there is coverage when an employee is out of office.
- Oversee training and orientation of new and current employees
- Support Therapy Operations coordinator to ensure manual and checklists are kept up to date.
- Participate in proactive team efforts to achieve departmental and company goals
- Comply with all company policies practices and procedures.
- Other duties as assigned.
Qualifications
Education and Work Experience
- Bachelors Degree in Business Healthcare Administration or related field . A combination of education and experience may substitute.
- Two 2 Five 5 years of experience in Healthcare Administration preferred.
Other Qualifications and Skills
- Ability to carry out detailed but involved written instructions able to problem solve with few variables.
- Ability to communicate clearly written and verbally.
- Adaptability and selfmotivated.
- Microsoft Office and database activity.
- Handle multiple tasks simultaneously.
Physical Demands/Working Environment
- While performing the duties of this job the employee is regularly required to stand sit; talk hear and use hands and fingers to operate a computer and telephone keyboard.
- Ability to sit at a computer for an extended period.
- Light to moderate physical activity and lifting is required.
- Specific vision abilities required by this job include close vision requirements.
- Moderate noise (i.e. business office with computers phone and printers light traffic
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
About KidsCare
Established in 2003 we are a pediatric home health agency serving children with special needs across the country. Our focus is on nursing speech physical and occupational therapy as well as providing case management for children up to 18 years of age. Founded upon the principle that patient care/therapy is most effective when it is oneonone set in a familiar environment and includes family member and caregiver involvement the organization has grown from its original roots in Dallas Texas to a multistate operation. Regardless of this growth however our original commitment of providing quality health care to every child and family serviced as never changed.
Required Experience:
Manager
Employment Type
Full-Time
