Supervisor, RCM Operations - Authorizations

Why Us?

With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.

Could This Be For You?

The Supervisor, RCM Operations oversees a team responsible for territory-level authorizations for the consolidated team. They guide their team in reviewing patient information to ensure active insurance coverage and obtain necessary paperwork for pre-certification, pre-determination, and pre-authorization before delivering scheduled devices and services. Additionally, they handle benefits, triage, document management, and authorization tasks as needed.  This role will be working with the West Coast.

Your Impact

• Promoting the values of Hanger.
• Reviewing documentation to ensure it meets the needs of each payer and is in alignment with payer medical policy and authorization requirements.
• Verifying payor requirements on the payor guide as well as payor portal and payor policies
• Communicating with clinic and consolidated staff to obtain necessary documentation.
• Communicating with insurance companies to verify patient benefits and authorization requirements.
• Submitting authorization request to insurance companies and follows up as needed.
• Coordinating with financial counseling team if items are determined to be not covered.
• Ensuring authorizations provided by insurance companies are accurate and contain correct codes, quantities, and appropriate authorization date ranges.
• Updating patient charts and worklog with necessary notations, authorization numbers, and documentation
• Contacting third-party payers to validate coverage or Authorizations as needed
• Contacting provider offices to obtain proper documentation needed for Auth Submission
• In the event of a denial of authorization communicating with clinic to determine if the submission of an appeal if appropriate. If appropriate submit the appeal to the payer and follow up as needed.
• Leading team by providing resources, training, monitoring volume, production and quality and providing feedback as needed to team.
• Efficiently prioritizing and organizing tasks to maximize productivity to meet SLA’s ad deadlines
• Perform other duties as assigned.

Minimum Qualifications

• High school diploma or equivalent. Associate degree in related field preferred.
• Knowledge of best practices related to benefits and authorizations.
• Minimum of 4-5 years of insurance verification and/or benefits experience. Minimum of 3 years in O and P industry and 1 year Minimum with Authorizations at Hanger
• Minimum of 1 year of experience hiring, supervising, training and coaching others.

Additional Success Factors

• West Coast Payor knowledge with IPA knowledge
• Proficient knowledge of benefits & authorization best practices and required compliance.
• Time Management to meet goals and deadlines
• Problem Solving and solutioning skills to issues that arise.
• Able to initiate communication with clinic staff and insurance companies.
• Excellent customer service and communication skills
• Ability to stay positive and calm under pressure
• Able to manage multiple responsibilities and to prioritize duties/tasks in a fast-paced working environment.
• Good interpersonal, oral and written communication skills, including the ability to follow written and verbal directions.
• Resourceful and flexible team player who excels at building trusting relationships with patients, referral sources and colleagues.
• Working knowledge of HIPAA and other medical insurance regulations and terminology for private payer, state and federal plans including coding, billing and reimbursement protocols
• Working knowledge of ICD-9, ICD-10, HCPC/CPT and other coding
• Proficient computer software, such as MS Word, Excel, and automated billing systems
• Knowledge of state, federal and regional collection, and reimbursement laws
• Must have an enthusiastic and positiv