SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health, dental, and vision benefits, life insurance and long and short-term disability, and more.
Key Essential Functions and Accountabilities of the Job
Supervise and coordinate the activities of the Pre-Access teams, including collaboration with external departmental staff assigned to specific disciplines for processing referrals and scheduling. This role serves as a point of contact for vendor management supporting Insurance Verification, Authorizations, and Patient Health Benefits. The Supervisor ensures productivity and quality standards are consistently met across all functions.
Monitor referral and authorization workflows to ensure timely acknowledgment, submission, and follow-up on pending requests. Serve as a subject matter expert on payer authorization requirements, regularly communicating updates to staff. Collaborate closely with scheduling, billing, third party vendors, and clinical departments to resolve authorization-related issues, and coordinate with Utilization Review (UR) to ensure medical necessity and appropriateness, helping to prevent claim denials.
Provide leadership and support to the Pre-Access teams through training, mentoring, performance evaluation, and ongoing coaching to promote professional development and operational excellence. Assist in hiring and onboarding new team members, ensuring alignment with the organization’s Mission, Core Values, and Vision. Assist in developing and maintaining standard operating procedures (SOPs) for Pre-Access processes, ensuring compliance with HIPAA and other regulatory requirements.
Generate and analyze performance reports to monitor team productivity, identify trends, and recommend process improvements. Participate in audits and implement corrective actions as needed to maintain compliance and operational excellence. Supports vendor management activities by monitoring performance against service level agreements (SLAs), communicating expectations and feedback, assisting in the evaluation and selection of third-party authorization service providers upon request, and collaborating with vendors to resolve issues timely and enhance service delivery.
Performance Metrics
Team Productivity: Assist in developing and implementing standard policies, processes, and procedure manual to ensure benchmarks are met per staff member.
Training Completion: Ensure 100% of new hires and existing staff complete required training within designated timeframes.
Referral Turnaround Time: Ensure referral acknowledgement within 72 hours and outreach/scheduling attempts typically within 5 business days of receiving all necessary information.
Referral Accuracy Rate: Ensure a minimum of 90%+ accuracy in worked referrals.
Authorization Turnaround Time: Maintain average turnaround time based on payer for all service types.
Authorization Accuracy Rate: Ensure a minimum of 90%+ accuracy in submitted authorizations.
Denial Rate: Keep authorization-related denial rate below 10% through proactive follow-up, training, and UR coordination.
Staff Quality Audits: Achieve 98%+ compliance in monthly quality audits of team members’ work.
Vendor SLA Compliance: Ensure vendors meet 99.99%+ of agreed-upon service levels prior to escalation.
Issue Resolution Time: Resolve internal, external, and vendor-related authorization issues.
Additional Details:
Education, Certifications, and Licenses
Preferred: Associate's or Bachelor’s degree
Preferred: HFMA, NAHAM, or equivalent Certification
Experience Required
Preferred: EHR in a hospital or multi-clinic setting experience
2 years’ healthcare experience, with at least 1 year in a supervisory or lead capacity.
Knowledge of
Knowledge of specialty billing; including but not limited to Optometry, Audiology, Home Health, Dental, etc.
Knowledge of IHS and non-IHS. Federal rules and regulations regarding hospital and outpatient billing.
Knowledge of technology and optimization for Insurance Verification Workflows.
Knowledge of Patient Access, Customer Service, Referrals, Authorizations.
Knowledge of private and governmental billing policies and practices to ensure compliance.
Knowledge of insurance claim forms including but not limited to Veterans Affairs.
Knowledge of ICD-10, CPT, HCPCS Level II Codes.
Knowledge of Medical Terminology.
Skills in
Maintain up to date education and knowledge of Revenue Cycle Operations.
Proficient using a keyboard and 10 key.
Proficient in Microsoft Office programs (i.e. excel, word)
Highly motivated, self-starter.
Attention to detail and accuracy.
Good organizational skills.
Good oral and written communication skills.
Problem solving and decision-making skills.
Ability to
Ability to multitask.
Ability to work in a fast-paced setting.
Ability to collaborate within cross-functional teams.
Other Qualifications
Excellent communication and interpersonal skills
Strong organizational & time management abilities
Teamwork
Proficient in EHR systems
Position Information:
Work Shift:ExemptIf you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!