Insurance Prior Authorization Assistant Manager

USA Vein Clinics Northbrook , IL 60062

Posted 7 days ago

The Prior Authorization Assistant Manager will provide support to the Insurance Department Manager in overseeing day to day operations of the insurance department team. The Assistant Manager will be responsible for overseeing staff KPIs and monitoring performance. This role will be heavily involved in process automation and strong Excel skills are necessary.

Responsibilities:

  • Reviews referring physician and patient documentation for Medical Necessity against insurance protocol requirements for pre-certification purposes.
  • Actively communicates with staff regarding status of authorization. Communicates the need for reschedule and/or cancellation if authorization not in-hand).
  • Direct liaison to offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements. Will be located on-site to allow for face-to-face interactions with patients and/or referring providers when necessary.
  • Responsible for scheduling STAT, emergent patients for outpatient diagnostic exams. Interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing and clinical information. Produces and distributes required forms with accurate patient information.
  • Respects and protects the patients rights to confidentiality and privacy and discloses information only for the professional purposes which are in the patients best interests with full consideration of their legal rights. Displays a positive attitude when interacting with providers office staff, providers and fellow employees.
  • Oversees insurance department staff and SOPs
  • Monitors KPIs for each prior authorization representative

Requirements

  • 5+ years medical insurance authorization experience in healthcare is required
  • Strong leadership experience within a healthcare setting
  • Previous experience with insurance pre-certification.
  • Knowledge of Microsoft Office (Outlook, Excel and Word) and EMR experience is preferred.
  • Effective Communication skills, ability to work in a high volume patient environment, results and goal oriented, ability to set priorities and meet deadlines, strong attention to detail, self starter, and Service Excellence skills.
  • Ability to multi-task effectively.
  • Quality improvement philosophy with high level of job accuracy, efficiency and dependability.
  • Knowledge of HIPAA.
  • Maintain 100% confidentiality relating to all patients, corporate, financial and proprietary information.
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Insurance Prior Authorization Assistant Manager

USA Vein Clinics