Surgical Authorization Team Lead - Hybrid

Description

Surgical Authorization Specialist Job Purpose: The Surgical Authorization Team Lead coordinates, leads, and is accountable for the activities of the Surgical Authorization Specialists. 

DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING 

· Oversees daily workflow of the Surgical Authorization Department.

· Oversees training, assistance, and in-service of all Surgical Authorization staff.

· Assist with resolving issues and complaints in a timely manner.

· Provides feedback for problem resolution and ensures compliance with state and federal guidelines.

· Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.

· Successfully works with payers via electronic/telephonic and/or fax communications

Responsible for verification and investigation of pre-certification, predetermination, and referral requirements for services.

• Determines medical necessity by reviewing the appropriate medical policies established for each insurance payer.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Communicates with patients, clinical navigators, financial counselors, and others as necessary to facilitate authorization      process.
• Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate      documentation in electronical medical record.
• Completes notification to all payers via electronic/fax/telephonic means within 24 business hours of service to ensure compliance with Managed Care contractual requirements.
• Follows departmental policies and procedures when necessary authorization is not obtained prior to service date.
• Answers provider, staff, and patient questions surrounding insurance authorization requirements.
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance.
• Adheres to Advanced Pain Care’s Policies and procedures.
• Performs other duties as assigned.

SUPERVISION: Surgical Authorization Manager 

Requirements

MINIMUM QUALIFICATIIONS

Education:  High School Diploma or GED required; Bachelor’s Degree preferred.

Experience:  

· Minimum of five years’ experience in billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO’s and PPO’s required 

· One or more years’ experience in a supervisory role in a healthcare environment required

· Medical Billing and coding experience required

WORKING CONDITIONS

Environmental Conditions: Medical Office environment

Physical Conditions:

· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F

· Must be able to sit for prolonged periods of time

KNOWLEDGE AND SKILLS:

· Excellent leadership skills

· Clear and effective communication

· Exceptional customer relations skills required

· Knowledge of billing terminology including CPT codes and ICD-10 codes

· Knowledge of online insurance portals

· Excellent typing and computer skills

· Effectively manages day by organizing and prioritizing

· Applies tactful principles and practices of dealing with the public

· Practices safety habits

· Protects patient information and maintains confidentiality