Job Description
Job Requisition Number 30493Full-time, 40 Hours/Week
8:30am - 5pm
Remote (Onsite for the first 90 days)
Applicant must reside in OH or PA
Summary:
The Team Lead Outpatient Authorization is responsible for overseeing the daily operations of the prior authorization team, focusing on therapy, behavioral health, diagnostic procedures, specialist visits, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine). This role ensures that the prior authorization process for these services is efficient, accurate, and compliant with payer requirements. The team lead provides guidance, leadership, and training to authorization representatives, collaborates with clinical staff, and ensures a seamless authorization process to prevent delays in care for our young patients.
Responsibilities:
- Leadership & Oversight: Lead and supervise the team of prior authorization representatives to ensure smooth, accurate, and timely submission and follow-up of authorization requests for therapy, behavioral health, diagnostic procedures, specialist visits, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine).
- Outpatient Services Authorization Management: Oversee the authorization process for outpatient services, ensuring all required documentation is accurate and submitted to insurers on time.
- Collaboration with Pediatric Providers: Work closely with clinical teams to gather necessary clinical information for prior authorization requests and ensure that the treatments are medically necessary and supported by the appropriate documentation.
- Training & Development: Provide ongoing training and development to the prior authorization team on best practices for outpatient services and payer-specific requirements.
- Escalation & Problem Resolution: Act as the primary point of contact for any complex or escalated authorization issues related to outpatient services. Work directly with insurance companies and healthcare providers to resolve authorization delays, denials, or issues in a timely manner.
- Data Tracking & Reporting: Maintain and report on key performance metrics for the prior authorization team, focusing on turnaround times, denial rates, and successful authorizations for specialty services. Provide actionable insights to leadership to improve processes.
Other information:
Technical Expertise
- In-depth knowledge of prior authorization processes specific to outpatient services.
- Strong leadership and team management skills, with the ability to motivate, train, and guide a team of specialists.
- Excellent communication skills, both verbal and written, especially in communicating complex authorization statuses to clinical teams, parents, and insurance providers.
- Detail-oriented and well-organized, with the ability to handle high-volume, complex cases for specialty services.
- Proficiency with electronic health records (EHR) systems, payer portals, and medical coding software.
- Ability to remain calm and effective under pressure, especially when handling high-priority or time-sensitive authorizations for critical services
Education & Experience:
- High school diploma or GED required. Associate degree or Certification in Healthcare Administration, Medical Billing, or related field preferred.
- Minimum 3 years in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; prior authorization, insurance verification, billing, customer service, etc. required. Minimum 1 year in a lead or supervisory role preferred. Experience with medical terminology, clinical documentation, or payer-specific insurance requirements is required.
- Preferred Certifications: Certified Healthcare Access Associate (CHAA), Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Insurance Specialist (CIS), Certified Clinical Medical Assistant (CCMA), Infusion Therapy Certification (CIT) (ideal for handling authorizations related to infusion therapies), Certified Coding Associate (CCA) (preferred for understanding medical coding processes)
Full Time
FTE: 1.000000
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