Authorization Supervisor

Job not on LinkedIn

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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👻 Ghost score 11%

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Methodist Le Bonheur Healthcare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1918

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Grant on 2021-06

Healthcare • Healthcare Insurance

Methodist Le Bonheur Healthcare is a comprehensive healthcare system serving the Memphis and Mid-South region since 1918. The organization provides a wide range of medical services, including emergency care, cardiology, cancer care, neurology, orthopedics, hospice care, and women's health. Methodist Le Bonheur Healthcare is focused on delivering quality healthcare with a compassionate approach, offering patient resources like financial assistance, patient portals, and support groups. Their facilities include numerous specialty hospitals such as Methodist University Hospital, Le Bonheur Children's Hospital, and more. Committed to community impact and faith-based health initiatives, the organization also offers educational resources and classes for healthcare professionals.

📋 Description

• Supervise and coordinate Authorization Specialists' work activities • Provide guidance, support, and direction to the department and staff • Supervise day-to-day operations and processes of the pre-certification department • Assist staff with implementing policies and procedures to improve departmental efficiency • Monitor diagnostic and surgical procedure volumes to ensure precertification efficiency • Support associates with complex pre-certification cases, ensuring protocols are followed and reimbursements are maximized • Work with payers to resolve technical problems and communicate changes affecting reimbursement and precertifications • Coordinate provider documentation to evaluate medical necessity, appropriateness, and efficiency of procedures • Build relationships with physicians, physician office staff, patients, and healthcare team members • Plan and schedule work, distribute assignments, and ensure adequate staffing • Monitor associate performance, clarify expectations, assist with goal setting, and promote cooperation • Hire, evaluate, counsel, train, issue corrective action, and recommend promotion or discharge of department personnel • Develop and implement orientation, training, and education processes • Participate in capital budget preparation, monitor and authorize expenditures, and help control costs and improve operations • Model behavior consistent with MLH Mission, Vision, and Values

🎯 Requirements

• Required technical degree or diploma in nursing • 5–7 years of experience in authorization or denials management • 5–7 years of clinical nursing experience • 5–7 years of precertification experience • Required Licensed Practical Nurse license in Tennessee from the Tennessee Board of Nursing • Proficiency in Microsoft Office, including Word and Excel • Extensive knowledge of insurance coverage practices, terminology, referrals, authorization/pre-certification, Medicare, and secondary payer rules • Experience with pre-certification and/or CPT medical codes • Demonstrated analytical ability to collect and interpret insurance and contract information • Clinical knowledge for managing complex surgical and invasive procedure precertifications • Experience with PPO and Managed Care insurance • Strong attention to detail and critical thinking skills • Experience with a computerized healthcare information system • Excellent verbal and written communication skills • Leadership, judgment, and supervisory skills • Good balance and coordination • Ability to perform light work, exerting up to 25 lbs. occasionally and/or up to 10 lbs. frequently • Close visual acuity for data and figure analysis, transcription, computer terminal viewing, and extensive reading

🏖️ Benefits

• Employer of choice and talent-rich organization where Associates can grow their career • Power of One culture • Commitment to the highest standards of care and unity • Low cost of living in Memphis