Position Summary:
The Referral and Authorization Team Lead is responsible for overseeing the authorization process for medical services and treatments. This role ensures that all necessary approvals are obtained from insurance companies and other payers, facilitating smooth and timely patient care. The Team Lead will manage a team of specialists, ensuring compliance with all relevant regulations and policies, and will work closely with healthcare providers, payers, and patients to resolve any issues related to authorizations and referrals.
Essential Responsibilities:
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Oversee and manage the referral and authorization process for medical services.
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Confirm the patient's insurance coverage and benefits.
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Ensure timely and accurate submission of authorization requests to insurance companies and other payers.
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Lead and support a team of referral and authorization specialists.
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Monitor the status of authorization requests and follow up as necessary.
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Collaborate with healthcare providers, payers, and patients to resolve any issues related to authorizations and referrals.
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Assign tasks and ensure team productivity.
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Ensure compliance with all relevant regulations and organizational policies.
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Provide training and ongoing support to team members.
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Implement process improvements to enhance efficiency and accuracy in the authorization process.
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Address complex authorization issues and escalate when necessary.
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Create and revise training materials and standard operating procedures (SOPs) for the team.
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Track key performance indicators and report team performance to management.
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Analyze authorization trends to identify areas for improvement.
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Performs related duties as required.
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Regular and reliable attendance required.
Education/Experience:
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High School Diploma or GED equivalent with courses to include typing, business English and office procedures or completion of vocational training for medical office.
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Certified Medical Assistant or Nursing certification strongly preferred.
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Minimum of two years’ experience in a medical office.
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Pre-certification experience strongly preferred.
Physical Demands:
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 talk or hear. Strong verbal and written communication skills required. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. Ability to exercise good judgment and handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. It must be detailed oriented and organized. Must be able to exercise good judgment and positively influence and lead others, including handling confrontations with poise and efficiency.
Position Type/Expected Hours of Work:
This is a full-time position. Days and hours of work are Monday through Friday between the hours of 8:00am-5:00pm.
Work Environment:
This position requires regular and reliable on-site attendance. Environmentally controlled medical environment. Fast paced environment with occasional high pressure or emergent situations.
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
EEO Statement:
White-Wilson Medical Center, P.A. and affiliates are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
