Authorization - Commercial - Team Lead

Authorization Team Lead

FLSA Classification: Non-Exempt
Department: Authorization (MassHealth & Commercial)
Reports To: Authorization Manager
Direct Reports: N/A

POSITION SUMMARY:
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.

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.

COMPETENCIES:

• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

REQUIRED QUALIFICATIONS:

• 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

PREFERRED EDUCATION AND EXPERIENCE:

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

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

• Occasionally required to stand.
• Occasionally required to walk.
• Frequently required to sit.
• Continually required to use hands and fingers.

TRAVEL REQUIREMENTS:

• Ability to travel locally by car to office(s), events, meetings, etc., as needed (approximately 5% or less of the time).

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Innovive Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Benefits:

Health Insurance, Paid Holidays, Vacation & Paid Time Off