Job Description
Job Requisition Number 30491Full-time, 40 Hours/Week
8:30am - 5pm
Remote (Training onsite first 90 days)
Summary:
The Supervisor Outpatient Authorization is responsible for managing the day-to-day operations of the prior authorization team that supports outpatient pediatric services, including therapy, behavioral health, diagnostic procedures, specialist visits, and advanced radiology (CT, MRI, PET, and Nuclear Medicine). This role directly supervises the Outpatient Authorization Team, ensuring high standards of productivity, quality, and compliance are consistently met. The supervisor will lead efforts to improve authorization workflows, collaborate with clinical departments, and support departmental initiatives aimed at enhancing efficiency and patient access. The supervisor is accountable for team performance, resolution of escalated issues, and ensuring timely and accurate processing of all outpatient authorization requests.
Responsibilities:
- Team Leadership & Management: Supervise the Outpatient Authorization Team and oversee daily operations, ensuring team members meet productivity and quality expectations. Foster a culture of accountability, collaboration, and high performance.
- Quality & Productivity Oversight: Set clear performance standards and monitor team metrics to ensure goals are met. Provide regular feedback and coaching to support continuous improvement.
- Outpatient Services Authorization Oversight: Ensure timely and accurate processing of prior authorization requests for outpatient services, including therapy, behavioral health, diagnostic imaging, and specialty visits. Focus on minimizing delays in care and ensuring compliance with payer requirements.
- Process Improvement & Compliance: Collaborate with manager on initiatives to improve operational efficiency and authorization outcomes. Lead efforts to identify inefficiencies and implement strategies to improve workflows and patient experience. Ensure adherence to payer guidelines, regulatory standards, and hospital policies.
- Training & Development: Develop and implement operational training programs for the authorization team. Ensure staff are well-versed in payer requirements, outpatient procedures, and best practices. Provide ongoing coaching and support.
- Escalation & Issue Resolution: Review escalated authorization issues. Work directly with insurance companies, clinical teams, and families to resolve challenges that may impact patient care or financial outcomes.
- Administrative and Reporting Oversight: Oversee team scheduling, performance evaluations, and departmental initiatives. Track and report on key performance indicators, challenges, and opportunities for improvement to leadership.
Other information:
Technical Expertise
- Strong leadership and team management skills with the ability to hold staff accountable for performance and quality.
- In-depth knowledge of prior authorization processes for outpatient pediatric services.
- Ability to manage authorizations and ensure timely approvals.
- Excellent communication and interpersonal skills for working with clinical teams, insurance representatives, and families.
- Proven ability to lead process improvement initiatives and drive operational efficiency.
- Proficiency with EHR systems, payer portals, and medical coding software.
- Strong problem-solving skills and ability to resolve issues related to authorization requests and denials.
- Office/Remote Setting: Primarily remote or hybrid, depending on department needs.
- Minimal Travel: Occasional travel may be required for team training or departmental meetings.
Education and Experience:
- Bachelor's degree in Business, Healthcare Administration, or related field, or equivalent years of relevant experience required.
- Minimum of 4 years of experience in Revenue Cycle, Patient Access, or Insurance roles related to prior authorization, insurance verification, billing, or customer service in a healthcare setting is required, with at least 2 years in a supervisory or management role or 3 years in a Team Lead role.
- Medical terminology, payer requirements and clinical documentation knowledge is required. Experience with pediatric outpatient services and payer authorization requirements is strongly preferred.
- Required Certifications: Certified Healthcare Access Associate (CHAA), Certified Revenue Cycle Representative (CRCR), Certified Insurance Specialist (CIS)
Full Time
FTE: 1.000000
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