Insurance Authorization Supervisor

6 days ago

Vadodara, India Qualifacts Systems, Inc. Full time

**Responsibilities**
- Serve as day-to-day lead for direct reports providing regular and timely mentorship and performance coaching. This includes having regular staff 1:1s, conducting performance reviews, creating development plans with support of department manager, assisting with hiring, handling administrative supervisory duties such as timesheet approval, time-off requests, and scheduling management.
- Provide supervision to team of direct reports and serve as a point of escalation for hands-on research and resolution of more complex usage issues and/or escalated concerns.
- Interact with support leadership and staff team members and ensure appropriate information is obtained to perform roles and drive timely solutions.
- Identifies patient pre-authorization/referral requirements and ensures they are met and in place in a timely manner to facilitate efficient billing and payment for multiple specialties
- Tracks and follows up on all pending authorizations depending upon payer guidelines
- Processes authorizations in a variety of methods, working with the payers to secure authorizations
- Verifies authorization quantities and effective dates are returned and processed correctly by the payers, and loaded correctly in all systems
- Organizes work to avoid lost revenue due to filing limitations
- Identifies opportunities to improve authorization efficiencies electronically via Availity, payer portals, etc.
- Reviews Outpatient and Inpatient accounts to identify if notification, authorization and/or referrals are required and obtains prior to service being rendered and within payer guidelines
- Reviews and submits authorization, referrals, and other medical necessities timely to ensure that patients can keep scheduled appointments, while following departmental procedures
- Facilitates timely telephone calls and online inquiries regarding status of outstanding referrals and/or authorizations and notifications
- Reviews, rectifies, and clears individual and batch Worklist errors and alerts to ensure account quality and accuracy
- Identifies accounts that have been postponed or cancelled and removes authorizations that are no longer valid and request updated authorizations
- Troubleshoots insurance denials and billing discrepancies and prepare paperwork for appeal submission regarding prior authorizations.

**Qualifications**
- Work experience in both billing and collections.

**Knowledge, Skills and Abilities**
- Knowledge of and ability to explain concepts of medical benefit plan design
- Excellent organizational, teamwork, and time management skills
- Highly motivated and detail-oriented
- Good troubleshooting skills

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