Authorization Specialist Team Lead

The Authorization Specialist Lead has an increased responsibility in assisting the Authorization Specialist Supervisor with training and monitoring the Authorization Specialists in their role of obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial, insurance-managed Medicare Advantage plans and other payors as required. This lead position will also be responsible for an assigned group of eligibility and authorization workflow.

Job Qualifications

Education :

High School Diploma or GED

Associate degree Preferred

Experience :

Minimum 2 years' experience in a medical-related field (preferably Home Health / Hospice)

2 years of medical prior authorization experience preferred.

EMR / Software : HomeCare Home Base, Availity, Microsoft Platforms Preferred

Knowledge and Skills :

As an Authorization Specialist Leader, you will play a crucial role in ensuring the smooth operation of our medical office and authorization team. Your primary responsibilities will include :

Strong knowledge of medical coding systems, including ICD-10

Familiarity with insurance verification processes and procedures

Proficiency in using medical office software and electronic health record systems

Attention to detail and ability to maintain accurate records and general payor documentation for the Authorization and Eligibility Team

Excellent communication skills, both verbal and written

Ability to work collaboratively with healthcare providers, insurance companies, and patients

Knowledge of procedure authorization and its direct impact on the company's revenue cycle

Understanding of payer medical guidelines while utilizing these guidelines to manage authorizations

Excellent computer skills, including Excel, Word, and Internet use

Detail-oriented with above-average organizational skills

Plans and prioritizes to meet deadlines

Excellent customer service and leadership skills; communicates clearly, effectively, and professionally at all times

Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

Transportation :

Reliable transportation with valid and current auto insurance.

Travel :

Environmental and Working Conditions :

Works in various settings and office environments, promoting functioning and coordination with all agency activities to ensure the highest level of professional care-the ability to work a flexible schedule.

Physical and Mental Effort :

Must be able to work under stressful conditions and time constraints of the agency or projects. Work requires sitting for long periods, bending, and stretching for files and office supplies. It may occasionally require lifting files or paper weighing up to 30 pounds.

Essential Functions :

Provide daily support to Auth Specialist by answering questions, clarifying processes, and troubleshooting issues.

Escalate performance or workflow concerns to the Supervisor, as needed

Maintain department training materials under guidance of Authorization Supervisor

Maintain portal access for all utilized portals to ensure coverage

Serve as the first point of contact for branch staff regarding eligibility and authorization questions

Provide input on process improvement opportunities to Authorization Supervisor

Lead team huddles in the Supervisor's absence to communicate updates / process reminders

Maintaining accurate and up-to-date records of authorizations and insurance information

Prioritize and ensure completion of all incoming authorization requests according to urgency. Address and / or suggest temporary reassignments to Authorization Supervisor if a temporary increase in branch workload is observed.

Obtain authorization via payer website / portal or by phone / fax and follow up regularly on pending cases

Collaborating with healthcare providers and insurance companies to resolve authorization issues

Obtain appropriate medical records from the source system to submit with prior auth per payor-specific guidelines

Other duties as assigned by Supervisor or Vice President.

Equal Employment Opportunity :

Traditions Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination of any kind based on race, color, sexual orientation, national origin, disability, genetic information, pregnancy or any other legally protected characteristic.