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Job Description

Job Requisition Number 30492

Full-time, 40 Hours/Week

8:30am - 5pm

Remote (Training onsite first 90 days)

Applicant must reside in OH or PA


Summary:

The Supervisor Specialty Authorization is responsible for managing the day-to-day operations of the prior authorization team that handles pediatric specialty services such as surgeries, injections, and infusion therapies. This role directly supervises the Specialty Prior Authorization Team, ensuring the team meets high standards of productivity, quality, and compliance. The supervisor will drive continuous improvement in authorization processes, ensure collaboration with clinical departments, and manage departmental projects aimed at improving efficiency and patient outcomes. The supervisor is accountable for overseeing the team's performance, addressing escalated issues, and ensuring that all authorization requests are processed in a timely and accurate manner.

Responsibilities:

  1. Team Leadership & Management: Manage the Specialty Authorization Team and oversee the day-to-day operations of the prior authorization team, ensuring all team members meet productivity and quality expectations. Lead by example in fostering a culture of accountability, motivation, and high performance.
  2. Quality & Productivity Oversight: Set clear expectations for quality and productivity and hold the team accountable for meeting department goals. Regularly monitor and evaluate team performance.
  3. Specialty Services Authorization Oversight: Ensure the team is processing prior authorization requests for specialty pediatric services, including surgeries, injections, and infusion therapies, with a focus on accuracy, compliance, and minimizing delays in patient care.
  4. Collaboration with Clinical Departments: Take the lead in collaborating with clinical departments, such as Surgery, Infusion Center, and HemOnc, to streamline authorization processes for specialty services. Work with department managers and clinical staff to ensure that the necessary documentation is obtained in a timely manner for complex cases.
  5. Process Improvement & Compliance: Drive initiatives for process improvements within the authorization workflow. Ensure the team adheres to payer guidelines, regulatory standards, and hospital policies. Manage efforts to improve both operational efficiency and authorization outcomes.
  6. Training & Development: Lead the development and execution of ongoing training programs for the prior authorization team on all operational workflows, ensuring that all team members are knowledgeable about payer requirements, medical procedures, and best practices for handling specialty service authorizations. Provide coaching and feedback to the team to enhance their skills and performance.
  7. Escalation & Issue Resolution: Take charge of managing complex and escalated authorization issues, working directly with insurance companies, clinical teams, and families to resolve challenges in a timely manner. Ensure that any issues impacting patient care or financial outcomes are addressed promptly.
  8. Collaboration on Departmental Projects: Support Patient Access manager as needed in cross-functional projects with clinical departments, collaborating with clinical leaders to improve the authorization process for surgeries, injections, and infusion therapies. Lead efforts to identify inefficiencies and implement strategies to improve workflows and patient care.
  9. Administrative and Reporting Oversight: Oversee team scheduling, performance evaluations, and coordination of department-specific projects. Monitor the team's progress on departmental goals and provide reports to upper management on key performance metrics, challenges, and opportunities for improvement.

Other information:

Technical Expertise

  1. Strong leadership and management skills, with the ability to oversee the team and hold the team accountable for performance, quality, and productivity.
  2. In-depth knowledge of prior authorization processes, particularly for pediatric specialty services such as surgeries, injections, and infusion therapies.
  3. Proven ability to manage complex, high-stakes authorizations while ensuring timely approvals and compliance with payer requirements.
  4. Excellent communication and interpersonal skills, especially when working with clinical teams, insurance representatives, and families.
  5. Ability to drive change and continuous improvement efforts within a high-performance team environment.
  6. Proficiency with healthcare IT systems, including electronic health records (EHR), payer portals, and medical coding software.
  7. Strong problem-solving skills, with the ability to resolve issues related to complex authorization requests and insurance denials.
  8. Office/Remote Setting: Primarily remote work
  9. Minimal Travel: Some travel may be required for team training or departmental meetings.

Education & Experience:

  1. Bachelor's degree in Business, Management or Health Care Field or the equivalent years of work experience required.
  2. Minimum of 4 years of experience in Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; utilization review, prior authorization, insurance verification, pharmacy, billing, coding, practice manager, etc. 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. 
  3. Medical terminology, payer requirements and clinical documentation knowledge is required. Working with pediatric specialty services such as surgeries, injections (biologics, immunotherapy), or infusion therapies is strongly preferred.
  4. Proven experience in managing teams to meet performance goals, including productivity, quality, and compliance.
  5. Required Certifications: Certified Healthcare Access Associate (CHAA), Certified Revenue Cycle Representative (CRCR), Certified Professional Coder (CPC) or Certified Coding Associate (CCA), Certified Medical Reimbursement Specialist (CMRS),
  6. Preferred Certifications: Pediatric Advanced Life Support (PALS) (optional, but beneficial for understanding pediatric care protocols); Infusion Therapy Certification (CIT) (preferable for overseeing infusion therapy authorizations)

Full Time

FTE: 1.000000


Status: Remote


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