Admissions Supervisor
About The Position
Supervises and supports a team of permanent and contingent Prior Authorization Representatives who are responsible for the data-entry of new enrollments and processing Prior Authorization. The supervisor will provide oversight for processing of claims and the resolution of all rejected medical and/or pharmacy claims. The supervisor will ensure that the team is trained and motivated. They will assist with hiring staff for incremental growth or re-staffing open positions. The role will validate the accuracy of the team's work and ensures that performance goals are met. Interfaces with a variety of internal and external customers including patients, physicians, account mangers, sales, pharmacy managers, contingent workforce managers, manufacturer representatives, reimbursement and upper management. Ensures that all HIPAA, policies/procedures and compliance requirements are met within the department.
Requirements
- Previous leadership/management experience
- Experience with Major Medical Insurance
- Pharmacy Technician License – required
- Knowledge of pharmacy benefit, rejection codes, and claims processing
- Knowledge of pharmacy and insurance terminology of coverage
- Knowledge of HCPCs codes
- Able to multitask and work in a fast-paced/changing environment
- Detail-oriented
- Excellent verbal and written communication skills
- Ability to work with a diverse group of employees
- Ability to work in a collaborative manner
Nice To Haves
- National Technician Certification – preferred
Responsibilities
- Monitors the production, volume, and quality of the work produced by the team using a variety of reports and audit tools. Makes daily adjustments to assignments to achieve maximum results. Ensures that account audits are completed daily and weekly.
- Establishes individual employee goals and provides timely performance feedback. Recognizes and rewards good performance. Addresses and resolves Human Resource issues following policies and procedures including disciplanary action. Escalates issues to HR appropriately. Completes yearly performance reviews.
- Conducts interviews, hires, trains, and motivates team. Interfaces with contingent workforce company managers. Makes certain employees have all needed tools including appropriate system access. Approves payroll for permanent and contingent workforce.
- Responsible for integration of new Specialty business for therapies handled by assigned team. Disseminates accurate information to the team.
- Functions as the main resource for questions regarding admissions policies and procedures. Resolves escalated Prior Authorizations and Specialty Benefits Verification issues. Collects and publishes data, establishes facts, draw conclusions, solves problems, and responds to inquiries. Ensures that other departments are involved when needed. Escalates IT problems appropriately.
- Responsible for helping to develop policies and procedures and process improvement strategies within the department. Communicates procedure changes to departments affected by that change.
- Perform other duties or projects as assigned.
Benefits
- Medical Coverage, Dental, and Vision Coverage
- 401(k) with employer match
- Accident and Critical Illness coverage
- Company-paid life insurance options
- Generous PTO, paid holidays, and floating holidays
- Tuition reimbursement program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
