Prior Authorization Department Lead

5 days ago


Boulder, Colorado, United States BoulderCentre for Orthopedics & Spine Full time
Job Title: Prior Authorization Department Lead

Job Summary:

We are seeking a highly skilled Prior Authorization Department Lead to join our team at Boulder Centre for Orthopedics & Spine. As a key member of our administrative staff, you will be responsible for leading the daily operations of the Prior Authorization Department, ensuring compliance with policies and regulatory guidelines.

Key Responsibilities:

- Provide direction to staff communicating with patients regarding the prior authorization process, including explaining requirements, terminology, billing process, consent requirements, and denials.

- Manage the PA Department workflow to ensure that Routine/Standard and Urgent/Expedited requests are compliant with regulatory and health plan requirements.

- Maintain knowledge of daily operations and all duties performed by the PA Department.

- Conduct analysis to identify process or individual staff performance barriers, implement interventions, and provide feedback to leadership or staff to correct deficiencies.

- Consult with the Department Director regarding staff performance issues.

- Serve as a liaison between the Department Director, physicians, and office staff in resolving prior authorization issues and answering questions.

- Maintain a current knowledge base related to insurance requirements for prior authorization and serve as the primary resource on prior authorization requirements.

- Develop and implement systems and procedures for prior authorization and denial management functions.

- Monitor adherence to established policies and procedures.

- Work with the IT Department on the installation of new computer applications.

- Obtain input from and coordinate workflows/processes with BCO clinical departments.

- Ensure equipment is in working order and recommend new equipment as needed.

- Analyze denial and adjustment reports and recommend changes to workflow and system edits as appropriate. Report metrics and trends to leadership.

Requirements:

- Associate's degree in business administration, accounting, bookkeeping, or secretarial science and three years of related experience in a physician business office; OR

- Graduation from high school or GED with five years of experience, including three years in a physician business office supervising the preauthorization process and at least one year of management or supervisory experience; OR

- An equivalent combination of education and experience.

Preferred Qualifications:

- Strong knowledge of electronic medical billing systems, third-party payer requirements, and medical terminology.

- Effective problem-solving, planning, and organizational skills to manage workflow and ensure efficient operations.

- Excellent communication and interpersonal skills to lead staff and interact with patients, physicians, and other departments.

- Ability to train, supervise, and motivate staff while driving continuous improvement in department performance.

- Proficiency in Microsoft Office and relevant practice management software.

Benefits:

- Company Paid Benefits

- Employee HDHP Plan

- Basic Life/AD&D – Guardian

- 16 days of PTO per year

- 7-7.5 paid holidays per year

- Employee Assistance Program

- 401(k) Safe Harbor Contribution

- Benefit Options Requiring Employee Contributions

- Medical

- Health Savings Account

- Dental

- Vision

- Short-Term Disability

- Voluntary Life and AD&D

- Flex Spending Accounts

- General Purpose Healthcare FSA

- Optional Protection Benefits (Accident, Hospital Indemnity, Cancer Care and Critical Illness Insurance)

- 401(k)

Equal Opportunity Employer:

Boulder Centre for Orthopedics & Spine is proud to be an Equal Opportunity employer. We are committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, age, disability, genetic information, marital status, sexual orientation, gender identity or expression, veteran status, or any other characteristic protected by applicable law.

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