Authorization Specialist

Job Profile
Department Location Authorization Supervisor Job role The RCM Authorization Supervisor will be responsible for managing the daily RCM authorization operations. The individual will need to have expertise in insurance authorizations, coverage and benefits reimbursement processes and regulations related to Oncology services. The successful candidate will collaborate closely with patients, physicians, and insurance companies to ensure that KPIs are met, and clients are satisfieded with the services rendered.

Key responsibilities Oversees the day-to-day operations and supervision of the Authorization team including drug, imaging, surgery, and radiation oncology. Routinely reviews and communicates payer authorization guideline revisions, including step therapy requirements, policy changes and decision trees to the Authorization sta. Communicates with physician/clinical sta on escalated reimbursement issues and/or o label drug usage utilizing guidelines set forth by the patients insurance. Oversee the orientation and training of new employees and can provide on-site training as needed. Provides expertise and guidance to the authorization sta. Develops policy and procedures ensuring best practice. Manage employee relations issues including hiring, discipline, coaching and performance evaluations. Maintains open communication with other RCM Leadership and Clinical sta. Provide backup clinic coverage assistance as needed to the Authorization Specialists. Routinely communicates with RCM leadership, escalating issues as necessary. Other duties assigned are to help drive our mission of improving the lives of everyone living with cancer. Stay current with industry trends, changes to insurance policies, and other developments that may impact on the collections process. Monitors and assesses business metrics to rene processes and improve eiciencies including benchmarking. Prepare reports for clients and leadership related to performance and productivity. Prepare payroll records and maintain employee attendance/audits for HR payroll processing. Manage employee activity such as hiring, job performance, evaluations, and disciplinary actions with appropriate approvals as required Lead team meetings and prepare minutes for distribution to team and management Other duties as requested and assigned by management Extensive knowledge of insurance payer guidelines and medical policies. Knowledge of ICD10, CPT and HCPCS codes required. Strong technical skills in Microsoft Oice Suite (Word, Excel, PowerPoint). Associates degree or equivalent experience required. 3+ years of experience in a community oncology setting preferred. 5+ years of RCM healthcare experience required including authorizations. 4+ years of supervisors preferred experience.