Operations Supervisor Prior Authorization - US Healthcare Account

Position Summary

The Prior Authorization Supervisor is responsible for overseeing the operations of the prior authorization department, ensuring compliance with payer guidelines, and managing staff. This role focuses on optimizing workflows, training team members, and ensuring the department meets performance standards.

Essential Functions

• Supervises and supports the prior authorization team leads and specialists.
• Develops and implements departmental policies and procedures to ensure operational efficiency.
• Oversees staff performance, conducting regular performance reviews and providing feedback.
• Ensures compliance with payer guidelines and regulatory requirements.
• Collaborates with other departments, such as billing and clinical services, to address issues and optimize workflows.
• Handles escalated issues, appeals, and disputes related to prior authorizations.
• Monitors and audits team performance and ensures that authorization requests are processed in a timely manner.
• Trains and onboards new team members assuring they have all resources needed to be successful in their roles.
• Manages escalated issues and work with payers and providers to resolve complex cases.
• Ensures team compliance with internal policies and payer regulations.
• Processes the most complex prior authorization cases including high-cost medications and procedures.
• Collaborates with clinical teams on cases requiring additional medical documentation.
• Leads process improvement efforts to enhance authorization workflows.
• Handles appeals for denied authorizations and follow up with payers for resolution.
• Serves as a point of contact for escalated authorization issues.
• Assists in reviewing insurance policies to ensure compliance with payer requirements.
• Coordinates with healthcare providers and insurance companies to resolve discrepancies.
• Ensures timely submission and follow-up on authorization requests.
• Maintains accurate records and documentation of all authorization activities.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
• Maintains accurate and detailed notes in the company system.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback to improve processes and policies.
• Attends all department, team, and weekly company meetings as required.
• Appropriately routes incoming calls when necessary.
• Meets company quality standards.
• Embraces and exemplifies Cardinal Health values: