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Under the supervision of the Manager of Insurance Authorization and Follow-up, the Team Leader of Authorization and Referral Management is responsible for the day-to-day leadership of insurance authorization staff and referral coordination staff.

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Core Duties:

+ Responsible for the daily management of the Insurance Authorization Unit (IAU), Referral Coordination including daily assignment of work and follow-up on staff questions.

+ Ensure that the Insurance Authorization Unit meets or exceeds productivity targets, and consistently secures authorizations for the full breadth and scope of services, including Inpatient/Observation, Diagnostic Imaging, Pharmaceutical (Infusion), Radiation Therapy and Surgical. Also responsible for working with the team to ensure speedy follow-up on denials or retro-authorization requests.

+ Responsible for ensuring team secures insurance referrals for all inbound South County Medical Group patient encounters.

+ Acts as the primary on-site insurance authorization subject matter expert for the ancillary departments to referring providers offices, insurance carriers, as well as patients.

+ As needed, researches payer rules and requirements as it relates to referrals or authorizations.

+ Collaborate with Case Management and UR department to secure inpatient or observation authorization as appropriate. If denied by the payer, working with UR to appeal the payer decisions where appropriate.

+ In collaboration with the Manager of Insurance Authorization and Follow-Up, responsible for following up on referral and authorization-related denials to minimize impact on accounts receivable

Other Duties:

+ Monitor unbilled accounts and identify sources of delay, where appropriate

+ Working collaboratively with Finance on any matters related to accounts receivable or cash postings

+ Participation in the RCM/SCMG meetings

+ Other duties as assigned

Minimum Qualifications:

+ Strong knowledge of insurance verification and authorization verification

+ Associate’s Degree or Equivalent Work Experience

+ At least 3 years of Authorization and/or Referral experience

+ Experience with payer portals for authorization and referrals

Required Certifications, Licensure:

+ n/a

Preferred Qualifications/Additional Skills:

+ Ability to communicate effectively with a diverse group of people using interpersonal and organizational skills.

+ Ability to organize, prioritize, and accomplish projects and tasks.

+ Advanced analytic skills