Supv Prior Authorization

Summary:
Under the general supervision of the Manager of Prior Authorization, supervises the integrity of each Lifespan Cancer Institute (LCI) location insurance prior authorization process. Leads the team of Patient Financial Advocates in the arrangement follow-up patient referrals, ensuring patient financial clearance from insurance companies have been received as well as possible trouble shooting as needed. Analyzes and provides process improvement updates and/or recommendations to the department manager.

Responsibilities:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Assists with interviews, orients, trains, and assigns work to staff. Evaluates performance and recommends corrective action as appropriate. Regularly assesses quality assurance reviews of work in progress. Provides guidance to staff regarding work processes, acting as resource to staff to resolve work-related issues.

Establishes, maintains and revises as necessary records and filling systems. Propose changes in work procedures to more effectively coordinate flow of work through area of responsibility.

Develops and maintains effective working relationships with other department personnel including physicians, department chiefs, division directors and department administrative personnel to expedite information exchange and resolution of common issues.

Collaborates or Conduct Peer to Peer discussions for appropriate parties to ensure pre-authorizations for denied services.

Ensures that all physician orders are complete, legible and scanned within the electronic medical record for viewing Coordinates all information for managing insurance denials including necessary follow-up and change in workflow associated with denials management.

Reviews variety of reports, WQ's and records to ensure that referrals and pre-authorizations from insurance companies have been received; also reviews for appropriate authorization to notify registration. Ensures staff is made aware of changes in hospital or third party procedures; ensures appropriate training and adherence to approved policies and processes directly or through supervisory staff.

Prepares and maintains various productivity and volume statistical reports associated with denied charges, or other reports requiring compilation, tabulation and/or display of data.

When necessary, contacts agencies outside the hospital to obtain pertinent patient information and to coordinate clinic/treatment programs. Confirms patient eligibility with insurance carriers in accordance with established policies. Obtains visit authorizations as necessary Arranges for and obtains all appropriate documentation from referring physician for patients.

Collaborates with various Lifespan personnel in order to resolve billing issues, prior-authorizations, denials and insurance denials/write-offs.

Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.

Performs all duties in accordance with Rhode Island Hospital's mission.

Other information:

BASIC KNOWLEDGE:

High School diploma or equivalency required. Level of knowledge of business systems, office procedures, and computer database and basic computer skills normally acquired through completion of one year post-secondary business program, or the equivalent.

Has a clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and registration information

Possess strong medical terminology knowledge.

Strong organizational skills to effectively plan, direct and manage high volume of orders requiring prior authorization.

Interpersonal skills to train and coach staff and to demonstrate effective customer relations and communications with others within and outside the Hospital.

Analytical skills to evaluate effectiveness of work flow, make recommendations for change and to develop, review and evaluate various records and reports.

Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations.

EXPERIENCE:

Two years progressively responsible experience in health care with a heavy emphasis in one or more of the following areas: patient care environment, healthcare operations, database management, documentation and departmental operations.

Knowledge of coding in a healthcare environment is a plus.

Excellent analytical and critical thinking skills and a focus for detail is needed.

WORK ENVIRONMENT ANDPHYSICAL REQUIREMENTS:

Work is performed in a normal office environment.

INDEPENDENT ACTION:

Performs independently in accordance with department's established policies and procedures. Complex issues are brought to the attention of the Business Operations Director for resolution.

SUPERVISORY RESPONSIBILITY:

Responsible for up to 8 FTE(s).

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: The Miriam Hospital, USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union