Job Duties and Responsibilities
- Prioritize incoming authorization and referral requests according to queue urgency
- Review patient's clinical and chart documentation related to the service submitted by the provider's office
- Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following methodsdepending on the payer's policy:
- Perform outbound calls to payer's authorization department
- Access payer's authorization online portal
- Submit faxes to payer's authorization department
- Respond to payer's clinical questions to be able to proceed with the authorization and referral requests
- Obtain and/or follow up payer's peer-to-peer review requirements and send them back to provider's office for the actual initiation
- Cater inbound calls from payers and perform necessary actions required for the task
- Listen and review voicemail messages from payers then perform necessary actions required for the task
- Monitor activities of Nurses to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management.
- Provide basic on-the-job training for direct reports and serve as a resource to address questions related to the policies, processes and procedures.
- Monitor, identify and resolve performance/behavior/attendance issues using prescribed performance management techniques.
- Adhere to all company policies and procedures.
- Adjust to the needs of meeting service level agreements under supervision of Manager.
- Ensure training needs of team members are met.
- Successfully complete all client related training and keep record of the same.
- Hold team briefings on a daily basis with the team.
- Communicate all process and client changes to direct reports within specific timelines and keep record of such updates.
- Act as a single point of contact for the assigned team members for all their job related needs and create a harmonious work environment.
- Escalate performance related issues with respect to assigned team members to Managers on a timely manner (PIP).
- Responsible for day-to-day functional supervision of work group, including work assignment and attendance monitoring; providing input into selecting, training, developing, and completing performance appraisal of work group(s) in accordance with the organization's policies and applicable compliance requirements.
- Employee separations to be handled in-line with company policies and HR
