Enterprise Supervisor Authorization Services

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The Supervisor of Authorization Services will oversee the authorization department. Will provide leadership and guidance to processes that will ensure the department is efficiently meeting the needs of the departments we support.

MINIMUM QUALIFICATIONS:

EDUCATION, EXPERIENCE, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent and five (5) years of experience in a healthcare revenue cycle setting
OR
Associates degree in Healthcare, Finance, Business Administration, or related field and three (3) years of experience in a healthcare revenue cycle setting.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree.

EXPERIENCE:

1. Two years of healthcare authorization experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Monitors staffing needs of the authorization team to ensure coverage is in place for referrals.

2. Provides leadership of high dollar services that would include analyzing the medical record for medical necessity and provide authorizations.  Acts as point of contact for assigned services that will interact with the clinical leaders in the department

3. Researches each request including reviewing medical policy to ensure each requests are processed with minimum delay and risk of denial.

4. Reviews staff productivity measures to look for trends and determines training needs that positively impacts efficiencies.

5. Provides prompt follow up with the Payor to ensure current authorization and accurate payment for the patient’s stay/treatment.

6. Participates in payor calls to provide trends with insurance carriers to make global improvements.

7. Utilizes de-escalation skills during clinic concerns arise with providers and staff.

8. Proactively communicates to staff any changes in payor information and follows up with payor to ensure services are authorized. Documents all changes and all payor information (i.e. DOS, Service (CPT/HCPC codes), LOC, Reference #, Authorization #, contact and phone number, and website used) appropriately.

9. Is trained on staff job functions and is able to help during peak volumes and also provide analysis to determine process improvements.

10. Attends relevant meetings with internal and external customer, and provides good customer service

11. Analyzes retrospective denials and how to make process improvements with the staff

12. Works closely with the clinic, financial services, financial counseling, and pre-service departments to support collaborative goals.

13. Monitors daily work assignments and makes changes to ensure good quality

14. Monitors work queues and assignments to ensure they are resolved timely

15. Reviews staff quality measures to look for trends and determines training needs that positively impacts efficiencies

16. Interview and screen potential employees and make recommendations to department manager or Director to aid in filling vacant positions

17. Provides coaching and counseling to staff based upon performance management principals

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for extended periods of time

2. Must have reading and comprehension ability

3. Must be able to read and write legible in English

4. Visual acuity must be within normal range

5. Must be able to communicate effectively

6 Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills

2. Excellent customer service and telephone etiquette

3. Must demonstrate the ability to use tact and diplomacy in dealing with others

4. Knowledge of ICD9/CPT Coding or Medical Terminology.

5. Knowledge of third party reimbursement.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

536 SYSTEM Hospital Authorization Unit