Procedure Authorization Supervisor Bilingual

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations and growing. TOI is changing oncology for the better.

JOB PURPOSE AND SUMMARY:

The Supervisor, Procedure Authorizations is responsible for overseeing the procedure authorization team to ensure timely and accurate processing of medical procedure authorizations. This role involves managing staff, streamlining processes, ensuring compliance with regulations, and liaising with healthcare providers and insurance companies.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Live and exemplify TOI core values, providing outstanding customer service and promoting a positive experience for patients and staff members.
• Assigning daily tasks to your team members.
• Conducting weekly huddles with team members to review performance.
• Conducting daily huddles with their team members to review weekly projects.
• Creating, reviewing, and administering corrective action forms with support and guidance from the Manager of Procedure Authorization.
• Motivating, evaluating, and counseling assigned team members.
• Managing field escalations, communicating delays to the Manager of Procedure Authorization.
• Supervising and coordinating the workflow by means of monitoring queue volume and aging or reviewing of reports/data.
• Educating and training/updating team members regarding policies and procedures, expectations, and outcomes.
• Tracking trends in authorization and/or medical review processes and complete reports as directed.
• Performing and supervising the basic functions of Authorizations, call queue and daily assignments.
• Working closely with the auditor to identify deficiencies and areas for improvement.
• Reviewing pending clinical notes and aged orders to be communicated to the Manager of Procedure Authorization
• Supervise and lead the procedure authorization team, including hiring, training, and performance management.
• Conduct regular team meetings to communicate updates, provide training, and address any concerns or issues.
• Develop and implement policies and procedures to improve the efficiency and effectiveness of the authorization process.
• Monitor team performance and productivity, ensuring that authorization requests are processed in a timely manner.
• Oversee the review and processing of procedure authorization requests.
• Ensure all the authorizations are obtained before services are rendered, in compliance with payer requirements.
• Manage complex or escalated authorization requests and issues.
• Maintain accurate and up-to-date records of all authorization requests and decisions.
• Ensure compliance with all relevant regulations, policies, and guidelines related to medical procedure authorizations.
• Serve as a liaison between healthcare providers, patients, and insurance companies to facilitate the authorization process.
• Address and resolve any issues or concerns raised by providers or patients regarding authorizations.
• Collaborate with other departments, such as billing and patient services, to ensure a seamless patient experience.
• Reporting and Analysis:
• Prepare and present regular reports on authorization activities, including volume, turnaround times, and issues.
• Analyze data to identify trends, areas for improvement, and potential process enhancements.
• Implement changes based on data analysis to improve the efficiency and effectiveness of the authorization process.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Strong leadership and team management skills.
• Excellent communication and interpersonal skills.
• In-depth knowledge of medical procedure authorization processes and healthcare insurance requirements.
• Ability to analyze data and implement process improvements.
• Proficiency with medical billing software and electronic health records (EHR) systems.
• Strong organizational skills and attention to detail.

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

• High School Diploma or equivalent. Associates degree preferred.
• Minimum of 3-5 years of experience in medical procedure authorization or a related field, with at least 1-2 years in a supervisory or leadership role.
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