Supervisor, Authorizations

Healthcare Outcomes Performance Co. (HOPCo)•Phoenix, AZ

7d•Hybrid

About The Position

This is a hybrid leadership position with remote and onsite responsibilities, requiring travel based on operational and organizational needs. The role demands availability during West Coast business hours and the ability to perform in a fast-paced orthopedic and surgical environment. Flexibility is key to support operational needs, escalations, and urgent patient care situations as they arise. Candidates must be comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.

Requirements

High school diploma or equivalent.
At least three years of experience in prior authorizations, insurance verification, or a related revenue cycle function, including professional authorization experience.
At least one year of supervisory, team lead, or comparable experience directing work and training staff.
Working knowledge of payer authorization processes, medical terminology, CPT/HCPCS and ICD-10 codes, and clinical documentation requirements.
Experience using electronic medical records, practice management systems, payer portals, and authorization tracking tools.
Strong organizational, communication, problem-solving, and coaching skills.
Ability to manage competing priorities, resolve issues, and hold staff accountable for timely, accurate work.
Hybrid leadership position with remote and onsite responsibilities
Travel required based on operational and organizational needs
Must maintain availability during West Coast business hours
Ability to perform in a fast-paced orthopedic and surgical environment
Requires flexibility to support operational needs, escalations, and urgent patient care situations as they arise
Knowledge of healthcare authorization and precertification processes, payer requirements, and medical necessity guidelines.
Knowledge of documentation standards and requirements needed to support authorization approvals.
Knowledge of referral, scheduling, and revenue cycle workflows and their impact on patient access and reimbursement.
Knowledge of regulatory, compliance, and organizational policies related to authorization activities.
Knowledge of denial trends, escalation protocols, and authorization risk mitigation practices
Skilled in preparing and submitting accurate, complete, and timely authorization requests.
Strong attention to detail to ensure documentation accuracy and completeness.
Skill in prioritizing workloads and managing multiple authorization requests within established deadlines.
Skill in identifying potential barriers to approval and proactively escalating cases to prevent delays.
Strong analytical and problem-solving skills to reduce preventable denials and authorization-related cancellations.
Effective communication and collaboration skills to coordinate with providers, clinical staff, payers, and facility teams.
Ability to monitor productivity and quality metrics and maintain performance standards in a fast-paced environment.
Ability to consistently meet departmental turnaround-time expectations for authorization processing.
Ability to evaluate authorization requests and supporting documentation for completeness and compliance.
Ability to recognize issues that may delay approval and take appropriate action to resolve or escalate concerns.
Ability to support strategies that reduce preventable denials, treatment delays, and canceled services.
Ability to maintain a high level of accuracy while managing competing priorities and deadlines.
Ability to provide reliable authorization support across facilities, departments, and stakeholders.
Ability to build and maintain productive working relationships that support efficient patient care and operational effectiveness.
Ability to adapt to changing payer requirements, processes, and organizational priorities while maintaining service excellence

Nice To Haves

Associate or bachelor's degree in healthcare administration, business, or a related field preferred.
Experience in orthopedic, spine, surgical, or other specialty authorizations.
Experience supporting hospital or ambulatory surgery center authorizations.
Familiarity with Athena, THRIVE, SIS, or comparable systems.
Experience with authorization denials, appeals, quality audits, and operational reporting.

Responsibilities

Supervise authorization workflows for professional services, including surgeries, office procedures, injections, imaging, and other services within the team's assigned scope.
Ensure staff verify eligibility, benefits, referral requirements, and payer authorization requirements before submission.
Confirm requests include the correct provider, procedure and diagnosis codes, service location, dates of service, and required clinical documentation.
Monitor submissions, pending requests, approvals, denials, and cases where authorization is not required; ensure status and supporting information are documented in designated systems.
Ensure changes to procedures, providers, locations, or dates of service are reviewed for authorization updates.
Coordinate requests for additional clinical information, peer-to-peer reviews, reconsiderations, and appeals with the appropriate clinical and revenue cycle teams.
Escalate unresolved cases and barriers according to departmental timelines, with clear ownership and next steps.
Assist facility authorization staff with assigned workloads, coverage needs, urgent requests, and complex cases.
Help verify that facility approvals match the scheduled service, facility, dates, and requested level of care, as applicable.
Coordinate professional and facility authorization requirements and track each approval separately when required.
Identify gaps between scheduled services and authorization records and work with the responsible teams to resolve them.
Communicate unresolved facility authorization concerns to the facility authorization manager. Follow established escalation and cancellation processes.
Assign daily work based on service dates, urgency, complexity, staffing, and queue volume.
Monitor productivity, quality, attendance, and completion of assigned work; address concerns promptly and consistently.
Provide onboarding, written training plans, cross-training, coaching, and ongoing education.
Conduct regular team huddles and individual check-ins to review priorities, barriers, and performance.
Complete quality audits, share findings, and follow up on corrective actions.
Reinforce departmental workflows, communication expectations, escalation procedures, and accurate documentation.
Support performance evaluations and corrective action in collaboration with the manager and Human Resources.
Review daily authorization queues and identify unstarted cases, aging requests, approaching service dates, and unresolved denials.
Maintain required dashboards, metric sheets, and pending-case reports.
Track authorization timeliness, accuracy, productivity, denial trends, and authorization-related delays or cancellations.
Investigate recurring authorization errors and implement improvements within the supervisor's authority.
Report trends, staffing concerns, and unresolved operational barriers to the manager with recommended actions.
Partner with scheduling, clinical teams, admitting, coding, billing, and follow-up staff to prevent authorization-related reimbursement issues.
Maintain awareness of payer requirements and communicate relevant workflow changes to staff.
Protect patient information and follow organizational privacy, security, and compliance policies.
Maintain complete, accurate records of payer communications and authorization decisions.
Recognize that authorization does not guarantee payment and escalate documentation or coverage concerns to the appropriate team.
Perform other related duties as assigned.