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Eligibility and Authorization Specialist Supervisor

3 months ago

Peoria, Arizona, United States Arizona Asthma and Allergy Institute Full time

Position Summary

The primary function of the Eligibility and Authorization Specialist Supervisor is to manage a team of eligibility and authorization specialists. This position is responsible for planning, organizing, and supervising the team who determines eligibility and authorizations for all patients from various insurance carriers. Identifies outstanding patient financial responsibility by creating financial estimates and notifying patients. This position is responsible for processing the financial clearance of each patient and ensuring successful payment of services rendered by overseeing the eligibility and authorization specialist team.

Reports To: Revenue Cycle Manager

Principal Duties and Responsibilities

  1. Oversee the eligibility and authorization process for all patients as a working supervisor.
  2. Manage a team of eligibility and authorization specialists.
  3. Collaborate with other departments to ensure timely and accurate processing of eligibility and authorization requests.
  4. Provide training and support to staff on eligibility and authorization processes.
  5. Monitor and analyze eligibility and authorization data to identify trends and areas for improvement.
  6. Maintain accurate records and documentation of eligibility and authorization activities by monitoring staff KPIs, reports, and data.
  7. Responsible for effective and efficient verification and authorizations of all patients' benefits.
  8. Utilization of electronic verification/eligibility technology or contacting insurance companies to verify and/or obtain patient eligibility and benefits.
  9. Verify existing patient insurance coverage and update the information in the practice management software system.
  10. Responsible for obtaining all referrals and authorizations for procedures and services, as required.
  11. Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected.
  12. Address rejected claims related to patient eligibility, authorization, or demographics.
  13. Responsible for answering incoming calls from other providers, recipients, and carrier groups in relation to insurance coverage.
  14. Ensures all patient questions are answered and issues are resolved timely by utilizing the appropriate resources.
  15. Develops and maintains effective relationships with the patients ensuring all patient demographic and insurance information is obtained and current.
  16. Maintain up-to-date knowledge of specific clinical services, registration, and pre-registration requirements for all departments.
  17. Maintain awareness of federal and state health care legislation and regulations, OSHA, and HIPAA.
  18. Proactively identifies and leads department process improvement opportunities.
  19. Develop and implement policies and procedures to improve the eligibility and authorization process.
  20. Maintain patient and company confidentiality.
  21. Other duties as assigned by the Revenue Cycle Manager.
Requirements

Required Skills, Knowledge, and Abilities
  • Strong knowledge of state and federal regulations related to eligibility and authorization.
  • Excellent communication and interpersonal skills
  • Strong leadership and management skills
  • Ability to analyze data and identify trends.
  • Excellent organizational skills and the ability to multi-task.
  • Ability to operate basic office equipment, answer multi-line telephones, and have a strong computer background.
  • Establish and maintain effective working relationships with patients, insurance companies, and staff.
  • Strong written and oral communication skills.
  • Knowledge and skills in working with computerized billing systems including practice management software and EMR.
  • Must adhere to all HIPAA guidelines and regulations.
  • Knowledge of medical insurance and authorization processes
  • Knowledge of medical terminology and experience working in a healthcare or insurance environment.
  • Knowledge of organizational policies, procedures, and systems.
  • Ability to document electronically and accurately.
  • Use appropriate guidelines for releasing information.
Education

High School diploma or equivalent with 5+ years of experience in the related field

Preferred Bachelor's degree in healthcare administration or related field

Experience

Minimum of 1 year supervision/management experience

Minimum of 3 years of experience performing insurance verification or working with medical insurance programs.

Experience with eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.

Other Requirements

Must be a team player with a positive attitude.

Working Conditions

OSHA Category 3: Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment. While performing the duties of this job, the employee is regularly required to sit, talk, use repetitive motion, and type.