Team Leader of Authorization and Referral Management

South County Hospital • Wakefield, RI • 2d ago

Under the supervision of the Manager of Insurance Authorization and Follow-up, the Team Leader of Authorization and Referral Management is responsible for the day-to-day leadership of insurance authorization staff and referral coordination staff.

Core Duties:

Responsible for the daily management of the Insurance Authorization Unit (IAU), Referral Coordination including daily assignment of work and follow-up on staff questions.

Ensure that the Insurance Authorization Unit meets or exceeds productivity targets, and consistently secures authorizations for the full breadth and scope of services, including Inpatient/Observation, Diagnostic Imaging, Pharmaceutical (Infusion), Radiation Therapy and Surgical. Also responsible for working with the team to ensure speedy follow-up on denials or retro-authorization requests.

Responsible for ensuring team secures insurance referrals for all inbound South County Medical Group patient encounters.

Acts as the primary on-site insurance authorization subject matter expert for the ancillary departments to referring providers offices, insurance carriers, as well as patients.

As needed, researches payer rules and requirements as it relates to referrals or authorizations.

Collaborate with Case Management and UR department to secure inpatient or observation authorization as appropriate. If denied by the payer, working with UR to appeal the payer decisions where appropriate.

In collaboration with the Manager of Insurance Authorization and Follow-Up, responsible for following up on referral and authorization-related denials to minimize impact on accounts receivable

Other Duties:

Monitor unbilled accounts and identify sources of delay, where appropriate

Working collaboratively with Finance on any matters related to accounts receivable or cash postings

Participation in the RCM/SCMG meetings

Other duties as assigned

Minimum Qualifications:

Strong knowledge of insurance verification and authorization verification

Associate's Degree or Equivalent Work Experience

At least 3 years of Authorization and/or Referral experience

Experience with payer portals for authorization and referrals

Required Certifications, Licensure:

n/a

Preferred Qualifications/Additional Skills:

Ability to communicate effectively with a diverse group of people using interpersonal and organizational skills.

Ability to organize, prioritize, and accomplish projects and tasks.

Advanced analytic skills

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