Supervisor Insurance Authorization

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Other information:

Job Summary
The Insurance Authorization Supervisor will provide supervision for the day-to-day operations in Insurance Authorization Services at Skagit Regional Health. On a rotational basis, the Insurance Authorization Supervisor will provide supervisory backup coverage and support in the following areas: registration, switchboard, diagnostic scheduling etc. The Insurance Authorization Supervisor is responsible for scheduling, training, orientation, in-service, monitoring and reporting quality metrics. Ensures all staff embodies the Mission, Vision and Service Standards of Skagit Regional Health resulting in a consistent positive patient experience. This position will work closely with the Patient Access Manager and Director to establish and maintain efficient and patient-focused processes.

Essential Functions
Manages personnel, including the performance appraisals, corrective action, staff development, and adherence to SRH Human Resources policies. Responsible for coordinating staffing schedules and maintain accurate schedule in the Kronos timekeeping system. Ensure accuracy and compliance of timecards each pay period with applicable collective bargaining agreements (CBAs) and policies. Oversees the authorization processes to ensure that the requests for pre authorization of medical treatments or services are processed efficiently and accurately. Ensures the authorization process complies with relevant regulations, policies and insurance guidelines and staying up to date with changes and regulations, policies and insurance. Responsible for training and development of staff and providing ongoing education on proper procedures and change in insurance policies. Providing education to healthcare providers ensuring necessary documentation to support authorization requests. A liaison between healthcare providers and insurance companies, communicating any issues or concerns that arise to include appealing denials. Tracking and analyzing authorization metrics to identify areas of improvement and ensure performance goals are met. Familiarity with current ICD-10 and CPT codes. Identify and monitor inappropriate trends in care to improve quality and cost effectiveness. Insurance authorization queue management, supervise the daily operation of the queues, monitor for compliance risk and update sills based on business needs. Monitor the results of delegations, assignments, or projects; taking in to consideration the skills, knowledge, and experience of the assigned individuals and characteristics of the assignment or project. Review and resolve daily exception reports. Audit for accuracy ensuring appropriate documentation regarding authorization is in the medical record and providing timely and consistent feedback in areas of excellence and deficiency. Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities. Coordinates orientation and training of new staff to ensure an effective, supportive and successful integration into the department. Plan and conduct regularly scheduled staff meetings with a strong education component. Assist with planning, developing and administering departmental policies and procedures, monitoring for compliance. Conduct interviews and make hiring decisions. Comply with all Skagit Regional Health policies and procedures. Perform other duties as assigned.

Education
High school diploma or equivalent required. Bachelor’s Degree preferred.

Experience/Training
Minimum of three (3) years insurance authorization experience in a healthcare setting required. Supervisory experience preferred.

License/Certifications
None required.

Other Skills
Must demonstrate strong knowledge of patient registration requirements in the hospital and clinic ancillary settings with understanding of healthcare insurance and revenue cycle. Must be knowledgeable of and comply with HIPAA regulations. Proficiency with Admission/Discharge/Transfer (ADT) systems, Excel and Outlook. Demonstrated leadership skills, mentoring and maintenance of a strong, patient-focused team. Demonstrates a high degree of organizational and analytical skills. Possesses excellent written and oral communication skills, and basic problem-solving and negotiation skills. Ability to work independently and exercise good judgment and problem-solving. Must be able to serve as a positive role model supporting team efforts and growth, addressing issues in a professional manner.

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. This position is very active and requires standing, walking, bending, kneeling, stooping, and crouching all day. The employee must frequently lift or move objects weighing over 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.