Insurance Benefits Authorization Manager

 

 

JOB TITLE: Insurance Benefits Authorization Manager

 

GENERAL STATEMENT OF DUTIES: The Insurance Benefits Authorization Manager will provide strategic leadership, oversight related administrative supervision, as well as direct assistance to a large team of frontline staff and an assistant manager when needed. The incumbent  will be responsible for forecasting, evaluating, strategically planning, and implementing, the processes of the insurance benefits coordination process. Must be able to effectively assign and oversee internal and external medical orders and have the ability to train new staff and perform annual evaluations of the front-line staff and the assistant manager.

 

SUPERVISION RECEIVED: Reports directly to Unit Director

 

REQUIRED KNOWLEDGE SKILLS AND ABILITIES – (EXAMPLES OF DUTIES):

 

1.           Have a working knowledge of industry related insurance authorization process in addition to insurance companies that serve the region.

2.           Serve as key point of contact on interviews and hiring of new employees and provide orientation training.

3.           Perform all required supervisory duties. To include:

a.     Complete employee 90-day and annual performance evaluations.

b.     Review and approve time sheets and leave requests.

c.     Counsel employees when difficulties arise. Develop and review remedial plans for problem situations.

d.     Maintain staff schedule and ensure optimum coverage levels.

2.     Assist the Assistant Manager with:

a.     Medical Records and Call Center related issues.

b.     Staff education

c.     Monitoring of faxes and incoming referrals.

d.     Monitoring of inbound and outbound calls.

3.     Coordinate with the full cycle billing department on:

a.     Following up on appeals

b.     Accounts for all patients

c.     Oversee billing inquiries

4.     Works closely with Senior Management on:

a.     Clinical Trends

b.     Hurdles/problems

c.     Development of workflow and processes

5.     Development and maintenance of policies and procedures.

6.     Leads meetings and training sessions when necessary.

7.     Stay up to date on all drugs used, the respective pharmaceutical companies, and assistance programs.

8.     Assigns and monitors medication orders in the referral tracking PHI software

9.     Supervise completion of following duties assigned to the coordinators:

a.     Benefit investigations (internal and external referrals)

b.     Order/Task assignments

c.     Prior-authorization and/or predeterminations

d.     Financial copay assistance programs and patient enrollments

e.     Patient financial responsibility counseling

f.      Scheduling of appointments

g.     Clinical care related alerts.

10.  Emails to physicians concerning delays in the benefit investigation, prior authorizations, and off-label cases.

11.  Become familiar and utilize ICD-10 and CPT coding to maximize functions and assist in the reimbursement processes.

 

EDUCATION: AA or BS degree preferred.

EXPERIENCE: At least five years’ experience working in a medical office. Extensive experience with health insurance companies is preferred. Minimum of 2 years managing or leading a team.