Overview:
Manages the day-to-day non-clinical authorization operations activities, including development and monitoring of internal processes, coordinating activities between the clinical and non-clinical staff, and managing support functions to facilitate efficient non-clinical authorization operations. Makes recommendations on operational improvements for the department. Works under general direction.
Responsibilities:
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Manages the implementation and operational management of the Authorization Operations Teams -policies and procedures to ensure compliance with DOH and CMS guidelines. Oversees the development, utilization, and evaluation of internal processes to ensure timeliness, customer satisfaction, efficient operations, and accurate and timely resolution for all complaints and issues.
- Acts as subject matter expert to internal staff and external Provider staff regarding authorization related requests and inquiries. Ensures that utilization management activities and operations are in compliance with federal, state and local health care regulations and standards of accrediting organizations; oversees the periodic review and audit to ensure compliance with program policies, state and federal regulations.
- Evaluates all relevant policies, procedures, and operational procedures; develops and implements revised plans, as appropriate. Collaborates with management to ensure adherence to all regulations, policies and guidelines.
- Directs investigations related to member complaints, concerns, or challenging member issues. Implements and manages workflow procedures and systems for an efficient and timely operation that is responsive to customers (members, caregivers, providers) and operational needs. Troubleshoots difficult customer service issues, facilitates problem resolution and directs staff in addressing and resolving day-to-day operational issues.
- Assists management team in the development of long and short -range objectives for department, which includes transitions, system and operational rollouts and coordination of non-clinical support functions across teams
- Provides input to the Education and Quality department regarding training needs for new initiatives. Participates in the overall planning, implementation and evaluation of such programs. Provides training to staff as needed.
- Works with management to develop and implement strategies and actions to improve the quality of the team’s performance, which includes participation in workflow reengineering, process improvement, risk mitigation and computer application development activities.
- Monitors adherence to regulatory and enterprise standards to ensure compliant operations and department’s readiness for internal and external audits
- Analyzes business operations, , utilization and schedules; contributes to systems design and implementation; and develops standards to measure, maintain and maximize efficiencies and meet operational needs.
- Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development budget, and hire, promotes, and terminates staff and recommends salary actions as appropriate, as well as maintains business continuity preparedness and contingency planning for the department.
- Participates in special projects and performs other duties as assigned.
Qualifications:
Education:
Bachelor's Degree in Business, Healthcare or other related industry, or the equivalent combination of work and experience required
Master's Degree in Business, Healthcare or other related industry preferred
Work Experience:
Minimum six ears progressive management experience, preferably in a customer service or health care environment; including a minimum of two years in a managed care/Health Maintenance Organization (HMO) organization required
Minimum two years managerial experience in management care required
Experience with writing and implementing program level policy and procedures and workflows required Proficient in Personal Computers applications, including Microsoft Word and Excel required Knowledge of medical terminology, and /or insurance terminology required
Strong knowledge of operations of manual and automated office systems and procedures required
Strong knowledge of third-party payer requirement for reimbursement preferred Strong operational skills with attention to detail required
Pay Range:
USD $77,200.00 - USD $96,500.00 /Yr.