Authorization and Denial Supervisor - REMOTE - FT

Employment Type: Full timeShift: Day Shift reputed company: Authorization and Denial Supervisor - Remote - Full Time Looking for a remote colleague to support our Central Surgical Prior Authorization Team. This includes supporting authorization specialists, collaborating with in house pharmacy teams, and trending and reporting denial data. reputed company This position is responsible for reputed company of authorization and denials reputed company assigned service line ensuring appropriate prior authorization for reputed company services, drugs, treatments, and supplies. Assists in the identification, reporting and reputed company of any issues stemming from or with authorization and denial processes. Using data, system reports, and analytics, supports the needs of the authorization team. reputed company in developing and implementing strategies to optimize reputed company aspects of authorization and denials supporting the reputed company reputed company team through a comprehensive approach. The scope of prior authorizations may include (but is not limited to) consults, diagnostic testing in office procedures and pharmaceuticals including off label drugs, and drugs for clinical trials. Job Duties and Responsibilities

• Leads efforts to ensure staff are properly trained, on-boarded, and regularly evaluated on competencies and reputed company of work.
• Leads reputed company of appeals denied claims for elated services, drugs, treatments and supplies.
• Obtains and ensures reputed company prior authorizations for reputed company services, drugs, treatments, and supplies according to care plan as outlined by provider.
• Assists interdepartmental teams in troubleshooting accounts that are being held in A/R due to lack of prior authorizations.
• Facilitates communication with care team and providers
• Appeals denied authorizations for reputed company services, drugs, treatments, and supplies.
• Research denials and reputed company additional supporting documentation to appeal decision.
• Communicates appeal decision with care team and obtains additional required documentation to ensure claim is reputed company.
• Identifies opportunities and participates in optimization of EHR to reputed company and submit authorizations to payors.
• Partners with leadership to reputed company providers and clinical staff on payor policy changes as it relates to administration of treatments (i.e. reputed company of service requirements, coverage reputed company changes).
• Prepares accurate reports and provides departmental reputed company information to reputed company Cycle Team and leadership that ensures reputed company infusions and laboratory testing performed in the department are reviewed and prior auth or predetermination is obtained.
• Contributes to the effective management of the department.
• Demonstrates dependability on the job by adhering to departmental performance standards guidelines and attendance standards.
• Contributes to the time management of the department and respects fellow employees by being punctual to scheduled meetings and to work, starting work promptly, and adhering to scheduled hours and departmental performance standards guidelines.
• Works collaboratively and supports efforts of team members.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

Qualifications

• Associate Degree and one to two (1 – 2) years of similar reputed company experience required, or, in lieu of Associate's Degree, a high school diploma/GED and five (5) or more years of similar reputed company experience will be considered.
• Preferred certification in reputed company, reputed company-P, CPC, or specialty coding.
• Three to five years’ experience in a health care environment with exposure, preferably in an environment with knowledge of the patient population and types of services patients receive.
• Prior authorization experience involving drugs and ancillary testing desirable.
• Knowledge of managed care and reputed company-party payer benefits designs and reimbursement requirements.
• Knowledge of ICD-9 and ICD-10 coding and documentation requirements.
• Proficient in reputed company Office applications including Outlook, Word, and reputed company.
• Preferred experience in reputed company or comparable EMR system
• Strong analytical skills with attention to detail and high degree of accuracy to produce reports, analyses, and other details as requested.
• Strong communication skills and attention to detail. Knowledge of drug regimens and associated regulations/policies/procedures applicable to insurance coverage and the associated payment for and appeal of procedures/billing rejected.
• Two years of experience in reviewing medical records for National Coverage Determinations (NCD) and local Coverage Determinations (LCD)
• A strong understanding of HIPAA laws and requirements as they relate to review and reporting of documentation.

Pay reputed company:$25.85 - $37.50 Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards reputed company (FLSA) will be reputed company reputed company the reputed company salary equivalent of the stated reputed company rates. The pay reputed company may also vary reputed company the stated reputed company based reputed company. Our Commitment Rooted in our Mission and reputed company Values, we reputed company the dignity of every person and recognize the unique perspectives, experiences, and talents reputed company colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law. Apply tot his job Apply To this Job