Supervisor, RCM Authorization Urology

About the role

The Supervisor, RCM Authorization will be responsible for managing the daily RCM authorization operations. The individual will need to have expertise in insurance authorizations, coverage and benefits, reimbursement processes and regulations related to Urology Procedures. The successful candidate will collaborate closely with patients, physicians, and insurance companies to ensure that KPIs are met, and clients are satisfied with the services rendered.

Responsibilities

• Oversees the day-to-day operations and supervision of the Authorization team including drug, imaging, surgery for urology-based procedures/treatments.
• Routinely reviews and communicates payer authorization guideline revisions, including step therapy requirements, policy changes and decision trees to the Authorization staff.
• Communicates with physician/clinical staff on escalated reimbursement issues and/or off label drug usage utilizing guidelines set forth by the patient's insurance.
• Oversee the orientation and training of new employees and can provide on-site training as needed.
• Provides expertise and guidance to the authorization staff.
• Develops policy and procedures ensuring best practice.
• Manage employee relations issues including hiring, discipline, coaching and performance evaluations.
• Maintains open communication with other RCM Leadership and Clinical staff.
• Provide backup assistance as needed to the Authorization Specialists.
• Routinely communicates with RCM leadership, escalating issues as necessary.
• Stay current with industry trends, changes to insurance policies, and other developments that may impact on the collections process.
• Monitors and assesses business metrics to refine processes and improve efficiencies including benchmarking. Prepare reports for clients and leadership related to performance and productivity.
• Prepare payroll records and maintain employee attendance/audits for HR payroll processing.
• Manage employee activity such as hiring, job performance, evaluations, and disciplinary actions with appropriate approvals as required.
• Lead team meetings and prepare minutes for distribution to team and management.
• Other duties as requested and assigned by management.
• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Required or Preferred Qualifications

• Extensive knowledge of Urology procedures/drug treatments (Required)
• Extensive knowledge of insurance payer guidelines and medical policies. (Required)
• Knowledge of ICD10, CPT and HCPCS codes. (Required)
• Strong technical skills in Microsoft Office Suite (Word, Excel, PowerPoint). (Required)
• Associates degree or equivalent experience. (Required)
• 3+ years of experience in a community urology setting. (Preferred)
• 5+ years of RCM healthcare experience including authorizations. (Required)
• 4+ years of supervisory experience. (Preferred)

Essential Competencies

• Attendance is an essential job function.
• Leadership: guides, motivates and develops others to achieve team and organizational goals.
• Communication: conveys information clearly and professionally, both verbally and in writing.
• Accountability: takes ownership of results and follows through on commitments.
• Problem solving: analyzes issues, exercises sound judgment and identifies effective solutions.
• Attention to detail: produces accurate, thorough and high-quality work.
• Time management: prioritizes and manages workload to meet deadlines.
• Adaptability: responds positively to change and new priorities.
• Teamwork and collaboration: builds productive working relationships across teams and departments.
• Customer focus: demonstrates a commitment to patients, physicians and other stakeholders.
• Integrity and compliance: acts ethically and follows organizational policies, HIPAA and regulatory requirements.

Additional information

This job description does not contain a full listing of activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

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