Job description

The Authorization Manager, in coordination with the department leaders, is responsible for planning, organizing, and supervising the daily operations of the Authorization Department. The Manager ensures that authorizations are processed in a timely manner, health plan protocols are followed and authorization information is communicated to clinical staff, physicians, and patients. The Manager must have a keen understanding of basic insurance concepts, and health plan policies. The supervisor will ensure that staff is aware of current health plan policies and is trained in all system requirements.

Essential Job functions:

• Provides leadership and support in problem solving within the Authorization Department, serving as a role model and consultant for the staff. Assists in interpreting policies & procedures
• Demonstrates the ability to make decisions and delegates responsibility to assure high quality performance and efficiency of the team
• Assists with management functions such as providing feedback on performance reviews, assistance with payroll, variance reports, and other daily operational functions. Provides feedback to the manager.
• Supervises and monitors the workflows for the team
• Monitors the reports and dashboards to ensure that authorizations and referrals are completed in a timely manner
• Research and correct claims on Hold or denied for authorization and referral documentation
• Document and provide education when changes or updates are made to the healthplans’ authorization policies
• Facilitate the submission of claims by ensuring that data is accurately recorded in Athena according to Summit Health CityMD's workflows
• All other related activities that lead to the successful adjudication of a claim
• Anticipates staff training requirements to ensure complete system knowledge, efficient
• processing of authorizations, and adherence to department workflows. Reports deficiencies to manager
• Plans and assists in the training of new hires to ensure they can demonstrate proficiency in Athena Collector and department workflows at the end of the probationary period.
• Demonstrates the ability to identify, analyze and resolve problems independently, and reports status to manager.
• Consults and communicates with physicians, staff, and patients in a way that is professional, supports the SHM CityMD customer service standards, and demonstrates subject knowledge.
• Demonstrates knowledge of the health plans’ authorization and billing guidelines to ensure maximized reimbursement of claims
• Reviews the medical record to supply documentation to support medical necessity and clinical policy guidelines
• Utilizes the necessary tools to ensure correct and efficient claim processing
• Manages appeals and peer to peer reviews for denied authorizations
• Demonstrates knowledge of the healthcare industry in regard to the revenue cycle, authorizations, and NJ state insurance laws.
• Runs regular meetings with the team, addresses workflow issues, and reports to the manager.
• Ensures that department work is prioritized on a daily basis and reassigns resources as appropriate.
• Manages the coordination, creation, and implementation of authorization related processes that may affect various disciplines of the organization to ensure accurate reimbursement
• Completes draft of yearly staff evaluations for manager’s approval and assists the manager in presentation to the evaluation to the employees
• Monitors departmental compliance with all applicable standards (SHM CityMD policy, HIPAA, and OSHA). Reports compliance concerns to the manager and ensures resolution of the issues
• Anticipates and performs necessary duties.

General Job functions:

• Expert in Athena Collector co-sourcing model
• Expert in research and resolution of authorization items in the Hold Bucket
• Keen understanding of generally accepted insurance benefit terms and processes
• Expert in Communication:

-Patient notes/Claim edit notes/Appointment notes
-Physician and office staff
-Manager/Director
-Payers

• Expert in Quick view, Insurance, Case Policy, Authorizations and Outgoing Referrals, all screens, tools, and data locations available under the user’s security access
• Athena Reporting, Excel spreadsheets, Microsoft Word and data locations available under the user’s security access.
• Establishes and maintains a positive work environment at all times.
• Works as a team member demonstrating respect for individuals and supports the goals of the team, co-workers, managers, and physicians.
• Consistently provides the highest level of customer service when interfacing with patients, co-workers and other SHM CityMD departments
• Co-ordinates with other supervisors and teams within the Revenue Cycle Department and the offices to ensure that authorizations are processed in a timely manner.
• Ensures that staff manages EHR documentation appropriately, passwords are in order, and all other HIPAA guidelines are followed in the department.

Physical Job Requirements:

• Physical agility, which includes ability to maneuver body while in place.
• Dexterity of hands and fingers.
• Endurance (e.g. continuous typing, prolonged standing/bending, walking).

Education, Certification, Computer and Training Requirements:

• Associate’s Degree Required
• Bachelor’s Degree Preferred
• 5-8 years' of work experience with medical insurance, preferably physician billing, expediting insurance referrals and pre-certifications, or claim adjudication.
• Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred.
• Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• insurance authorizations (end to end): 4 years (Required)
• people management: 4 years (Required)
• Authorization platform: 3 years (Preferred)
• EMR (Athena preferred): 3 years (Preferred)

Work Location: Remote

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