Supervisor, Pre-Certification
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Job Location:
Monthly Salary:
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Job Details
Corporate - Tennessee
Fully Remote
Full Time
High School Diploma/GED
Other Positions
Description
US Heart and Vascular is looking for a Remote Prior Authorization Supervisor to join our team.
Responsibilities:
- Provide analytics and trends regarding front end billing functions to leadership.
- Plans and structures the prior authorization eligibility and financial counseling department workflow and staffing.
- Reviews staff performance logs and identifies performance issues.
- Works with and trains staff to help improve performance.
- Oversees the training of staff.
- Monitor prior authorization eligibility medical necessity frequency and non-covered denial trends to identify root-cause.
- Maintain a current knowledge base related to insurance requirements for prior authorization. Serve as primary resource on prior authorization requirements for government payers and USHVs contracted payers.
- Work collaboratively with clinical staff and leaders on issues related to prior authorization and eligibility issues.
- Work with the patient services team on escalated patient outreach related to prior authorizations eligibility and financial counseling.
- Develop and document USHV internal policies and procedures around prior authorizations eligibility and financial counseling.
- Ensures the team is timely and accurate with insurance authorizations prior to services being rendered.
- Oversees the team that verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
- Supervises the team responsible for verification and investigation of pre-certification authorization and referral requirements for services.
- Ensures the team coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits.
- Determines a system to prioritize workload to ensure the most urgent cases are handled in a timely manner.
- Creates departmental policies and procedures for when authorization is not obtained before the service date.
- Implement a process of collecting balances prior to the service date.
- Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
- Answers provider staff and patient questions surrounding insurance authorization requirements.
- Performs other related duties as assigned.
Requirements:
- Bachelors degree or 3-5 years relevant experience solving complex healthcare problems required.
- Extensive experience in healthcare revenue cycle and provider operations.
- Strategic thinker with strong business acumen and analytical skills.
- Knowledge of revenue cycle management practices and challenges.
- Understanding of healthcare industry revenue services and technology landscape with a strong network of contacts.
- Ability to perform responsibilities with minimal supervision exercising discretion and independent sound judgment while excelling in a fast-paced results-oriented environment.
- Proficient in clinical documentation review for alignment with insurance authorization requirements
- Incorporate a leadership mindset to your role.
Required Experience:
Manager
Key Skills
- Web Content
- Editor-In-Chief
- Freelance Writers
- Press Releases
- Online
- HTML
- SEO
- Internet
- Content Marketing
- Edit Copy
- Editorial Staff
- News Stories
- Analytics
