Supv. Authorization and Eligibility Operation - Remote

Public Partnerships LLC supports individuals with disabilities or chronic illnesses and aging adults, to remain in their homes and communities and “self” direct their own long-term home care. Our role as the nation’s largest and most experienced Financial Management Service provider is to assist those eligible Medicaid recipients to choose and pay for their own support workers and services within their state-approved personalized budget. We are appointed by states and managed healthcare organizations to better serve more of their residents and members requiring long-term care and ensure the efficient use of taxpayer funded services.

Our culture attracts and rewards people who are results-oriented and strive to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, entrepreneurial environment, and who want to make a difference in helping transform the lives of the consumers we serve. (learn more at www.pplfirst.com).

Duties and Responsibilities:

• Oversight of day-to-day authorization and eligibility operations
• Responsible for the timely correspondence and communication with clients regarding authorization process information
• Works in conjunction with Sr. Director and Manager to ensure business needs are met
• Managing and supporting team to ensure authorization activities are conducted in a manner consistent with overall company and client protocol
• Observes compliance with Federal, State, and payer regulations, guidelines, and requirements
• Participating in development and implementation of operating policies and procedures.
• Counsels on best practices program setup.
• Seeks and identifies opportunities for process improvement.
• Reviews and approves Business Requirements Documents.
• Providing advice on EDI review solution designs
• Developing and supporting a paperless (electronic) system for receiving authorizations
• Reports authorization activities to the Executive Leadership Team
• Determines resources needed to support business growth
• Obtain authorization of services to be paid as required by program rules from designated State Clients according to payer requirements in a timely manner.
• Monitor and track authorizations for date and unit exhaustion. Responsible for timely correspondence and communication with providers regarding authorization information
• Ensure authorization requests are completed in a timely fashion to meet contractual requirements, and all reviews are conducted using nationally recognized and evidence-based standards.
• Develop and continually evaluate the authorization process and tools, monitor productivity measures/targets including turnaround time. Identify and address opportunities for improvement in efficiency, accuracy, and appropriateness of the program.
• Assist with maintenance and integrity of the authorization written policies to ensure they are accurate, comprehensive, and clear.
• Develop and implement necessary systems for implementing an Authorization Program including Business Requirement Documents.
• Serve as the subject matter expert liaison for authorizations and/or leader on cross-functional teams.
• Supervises staff and hold team accountable to metrics and KPIs
• Manages team including hiring, terminations, team building, reviews, goal setting, succession planning, and overall performance.
• Excellent Management skills

Required Skills:

• Prior experience with eligibility and/or authorizations a plus.
• Excellent written and oral communication skills.
• Strong technical skills in Microsoft Office applications, including Word, PowerPoint, Excel
• High attention to detail and strong team attitude.
• Comfortable in a dynamic company environment with frequent changes in direction.
• Ability to function in a fast-paced and dynamic work environment.
• Ability to build and maintain relationships with payers, providers, and gov agencies
• Skill in planning, organizing, and supervising.
• Strong critical thinking and problem-solving skills.
• Excellent organizational skills with an attention to detail.
• Understanding of Relational Database Systems Preferred
• Experience of healthcare data and industry-driven changes including EDI and Healthcare transactions
• Excellent Management skills.

Qualifications:

• Education: Related Bachelor’s Degree Preferred or relevant experience
• Experience: Minimum of five (5) years of experience serving individuals with disabilities and/ or aging adults preferred.

Other Requirements:

• Criminal Background Check
• A valid driver’s license, access to a motor vehicle, and active vehicle registration, inspection and insurance certification required

Compensation & Benefits:

• 401k Retirement Plan
• Medical, Dental and Vision insurance on first day of employment
• Generous Paid Time Off
• Continuing Education Assistance Program
• Employee Assistance Program

Public Partnerships is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PPL will not tolerate discrimination or harassment based on any of these characteristics.