Prior Authorization and Patient Financial Counseling Supervisor

Description

The Prior Authorization and Patient Financial Counseling Supervisor (PA/PFC Supervisor) is responsible for supporting Prior Authorization Specialists and Patient Financial Counselors from a technical and workflow perspective. The PA/PFC Supervisor is responsible for the day-to-day operation of the department and establishing policies, reviewing departmental procedures and systems for efficiencies and implementing changes. This position is responsible for evaluating the effectiveness of personnel, the quality of work completed as well as insuring necessary communication between staff, medical providers, leadership, and at times, patients. The PA/PFC Supervisor is responsible for accurate, compliant, and timely prior authorization, payment and collection for services both professional and technical as well as compliance to hospital standards and governmental regulations. 

Essential Duties and Responsibilities:

1. Operational Accountability

• Assist the Patient Financial Services (PFS) Manager in the development, implementation, and evaluation of the Business Office. 
• Collaborate with PFS Manager and other leadership to ensure the necessary resources are in place to execute the work of the department.
• Ensure appropriate documentation is occurring in accordance with EMR requirements and relevant compliance and policy obligations. 
• Assist the PFS Manager in identification of staff learning needs and development of education and competency plans consistent with unit, service line, and organization priorities, coordinates implementation of unit-based education and assists in evaluation of outcomes.
• Establish processes to assure equipment function, repair process, and routine maintenance on day-to-day basis. 

2. Staff Management and Development

• Maintain open, effective communication with PFS Manager regarding development and performance of unit personnel.
• Plan, direct, and guide work of direct reports.
• Ensure staff are appropriately trained and competent in performance of assigned duties; assess competencies of staff on a regular basis in accordance with established standards and practices.
• Coach, mentor, and develop staff to promote skill development.
• Assist in hiring initiatives; generate requisitions, coordinate interview team, conduct interviews, select staff to fill open positions, establish training plan, assist with orientation and onboarding activities
• Onboard, orient, and provide ongoing coaching, mentoring and support to staff. Model and teach these skills to others.
• Conduct annual evaluations and necessary corrective action for assigned staff. 
• Apprise and educate staff in new/changed regulations, policies and procedures, and compliance. 
• Collaborate with preceptors to coordinate the orientation plan and schedule for each employee, based on a baseline individual learning needs assessment.

3. Revenue Cycle Accountability 

• Develop plans and programs for the Prior Auth and PFC Revenue Cycle teams and ensure that goals and objectives of the team are properly defined and clearly established.
• Implement team plans, programs, and projects adhering to prescribed deadlines and schedules
• Develop policies, guidelines, and implement procedures and ensures consistent company-wide implementation
• Evaluate effectiveness of financial assistance policy & collection efforts. Oversee financial assistance policy, program, and processes. Ensure compliance with 501r regulations
• Evaluate effectiveness of prior authorization workflows and department collaboration. Oversee prior authorization policy, program, and process. Ensures compliance with payer requirements and medical policy.
• Enhance and standardize workflow processes throughout the revenue cycle to assist in achieving consistency
• Prepare and analyze prior authorization, denial, collection and FAP reports, weekly and monthly work volume reports in conjunction with the PFS Manager.

* While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from jobs and to assign other duties, as necessary.

Requirements

Education & Licensure:

• Bachelor’s degree in Business Administration, Health Administration, Medical Billing, or other relevant program preferred. 
• CAH/RH