Prior Authorization Supervisor

Cook County Government•Matteson, IL

13d•Onsite

About The Position

The Prior Authorization Manager supervises, consults, and guides prior authorization staff responsible for responding to all prior authorization requests. The Prior Authorization Manager ensures all requests are complete to include inpatient, outpatient, procedures, and therapies in accordance with best practices, Cook County Health (CCH) Policies and Procedures and Health Plan standards. The Prior Authorization Manager ensures all documentation is obtained to support level of care, medical appropriateness, and authorization. General Administrative Responsibilities Collective Bargaining Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals Participate in collective bargaining negotiations, caucus discussions and working meetings Discipline Document, recommend and effectuate discipline at all levels Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements Supervision Direct and effectuate CCH management policies and practices Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements Management Contribute to the management of CCH staff and CCH’ systemic development and success Discuss and develop CCH system policies and procedures Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements Work with Labor Relations to discern past practice when necessary Typical Duties Oversees the day-to-day operations and supervision of the Prior Authorization team including drug, imaging, surgery, radiation oncology, etc., providing expertise and guidance across Cook County Health. Routinely reviews and communicates payer authorization guidelines, and policy changes to the Prior Authorization staff. Communicates with physician/clinical staff on escalated reimbursement issues and/or off label drug usage utilizing guidelines set forth by the patient’s insurance. Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Oversees the orientation and training of new employees and provide on-site training as needed. Provides backup coverage as needed to the Prior Authorization team. Performs monthly audits for each employee to ensure data quality, insurance verification, and overall account documentation compliance. Recommends action to outside stakeholders, as necessary, to resolve problems proactively. Remains current with industry trends, changes to insurance policies, and other developments that may impact the authorization process. Engages in process and quality improvement initiatives. Complies with patient confidentiality policies for the retention of patient information, handling, distributing, or disposing of patient health information. Reports to the Prior Authorization Manager. Performs other duties as assigned

Requirements

High School diploma or GED equivalent with six (6) years of prior authorization experience or Bachelors with three (3) of prior authorization experience
A minimum of Four ((4) years of experience processing insurance request to obtain prior authorization.
Experience and familiarity with using insurance portals, i.e., Anthem, Availty, Evicor, Covermymeds, Magellang.
Must provide copy of official college transcripts at time of interview
Must meet all required qualifications at time of application filing.

Nice To Haves

Knowledge and experience with payer processes to submit appropriate clinical documentation
Experience using Medical Terminology

Responsibilities

Oversees the day-to-day operations and supervision of the Prior Authorization team including drug, imaging, surgery, radiation oncology, etc., providing expertise and guidance across Cook County Health.
Routinely reviews and communicates payer authorization guidelines, and policy changes to the Prior Authorization staff.
Communicates with physician/clinical staff on escalated reimbursement issues and/or off label drug usage utilizing guidelines set forth by the patient’s insurance.
Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
Oversees the orientation and training of new employees and provide on-site training as needed.
Provides backup coverage as needed to the Prior Authorization team.
Performs monthly audits for each employee to ensure data quality, insurance verification, and overall account documentation compliance.
Recommends action to outside stakeholders, as necessary, to resolve problems proactively.
Remains current with industry trends, changes to insurance policies, and other developments that may impact the authorization process.
Engages in process and quality improvement initiatives.
Complies with patient confidentiality policies for the retention of patient information, handling, distributing, or disposing of patient health information.
Reports to the Prior Authorization Manager.
Performs other duties as assigned
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Contribute to the management of CCH staff and CCH’ systemic development and success
Discuss and develop CCH system policies and procedures
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary