Authorization - Commercial - Team Lead

Innovive Health•Medford, MA

6d•Onsite

About The Position

The Authorization Team Lead is a part of a fast-paced and dynamic department that plays a crucial step in making sure that patients are eligible to receive our services. The individual filling this position is an expert in medical insurance and in the tools that we use as a team to fulfill authorization requirements, i.e., Netsmart’s MyUnity, Salesforce, Microsoft Teams, Excel, and Outlook. As an expert, you will investigate the challenges the auth reps encounter and escalate to the Authorization Manager as needed. The Team Lead is an ambitious, hands-on problem solver, and effective communicator that will support the achievements of the team. The role includes the following: insurance verifications, obtaining authorization, patient eligibility, and data interpretation.

Requirements

Associate degree or equivalent in related work experience
1+ years’ experience in an office setting
1+ years’ experience in Prior Authorization Department
Proficiency in Microsoft Office
Proficiency in Salesforce
Proficiency in collaboration tools

Nice To Haves

2+ years’ experience in a home healthcare environment
Proficiency using NetSmart

Responsibilities

Serve as a liaison between Authorization Manager and representatives.
Collaborate with Authorization Manager and use the data to prioritize clearly defined high-priority items.
Train existing and onboarding reps on daily tools and processes.
Lead scrum meetings with prepared agenda.
Run various reports to keep up with patient caseload and UR Maintenance.
Obtain prior authorization or pre-certification of services to be rendered as required by each individual payor.
Answer incoming telephone calls and triage to appropriate personnel as indicated.
Complete and manage all paperwork or supportive documentation required for performing effective billing.
Re-verify patient eligibility, monitor insurance lifetime caps and prior authorization periods.
Resolve patient/payor issues in a timely manner.
Participate in departmental, clinical and company meetings/trainings as requested.
Performs other duties as assigned.