Authorization Supervisor - FT days
- Category
- Prior Authorization
- Job Type
- Full time
- Job ID
- R-20555
If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
A Brief Overview
Supervises and coordinates the work activities of the Authorization Specialists. Provides guidance, support, and direction to the department. The incumbent is also responsible for precertification of eligible medical services and procedures for diagnostic and outpatient services. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
What you will do
- Supervises day to day departmental operations and processes of the pre-certification department. Provides guidance, support and direction to the department and staff.
- Assists staff with the understanding and implementation of policies and procedures to increase the overall efficiency of the department.
- Actively monitors and oversees the quantity of diagnostic and surgical procedures to ensure efficiency of precertification.
- Works with associates in complex pre-certification cases, ensuring protocols are followed and reimbursements are maximized.
- Works with payers to resolve technical problems and keep up with communications to eduate the team on changes that may affect reimbursement and precerts.
- Coordinates all documentation submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of medical procedures.
- Establishes a good working relationship with physicians, physician office staff, patients, and other members of the healthcare team.
- Plans and schedules work ensuring distribution of assignments and adequate staffing based on workload and productivity standards.
- Monitors Associates performance and clarifies work expectations, assists with goal setting, and promotes cooperation among individuals and groups.
- Maintains and develops a competent, productive, and quality conscious workforce by hiring, evaluating performance, counseling, training, issuing corrective action, and recommending promotion or discharge of department personnel according to the MLH value system.
- Develops and implements processes through orientation, training and education to ensure that the competence of all staff members is assessed, maintained, improved and demonstrated throughout their employment.
- Participates in the preparation of the capital budgets for assigned area(s), monitors and authorizes expenditures within budget limits. Assists in the development and implementation of capital budget and plans to control costs and improve department operations.
Education/Formal Training Requirements
- Required - Technical Degree or Diploma Nursing
Work Experience Requirements
- Required - Authorization or Denials Management 5-7 years
- Required - Clinical nursing 5-7 years
- Required - Precertification 5-7 years
- Preferred - Case Management 5-7 years
- Preferred - Lead, Supervisory, or Management
Licenses and Certifications Requirements
- Required - Licensed Practical Nurse - Tennessee - Tennessee Board of Nursing
Knowledge, Skills and Abilities
- Proficient in Microsoft Office such as Word and Excel.
- Extensive knowledge in insurance coverage practices, terminology, and requirements for referrals and authorization/pre-certification used by third party payers, Medicare, and secondary payer rules.
- Experience working with pre-certification and/or CPT medical codes.
- Demonstrated analytical ability to collect and interpret insurance and contract information. Uses clinical knowledge to effectively manage pre-certifications for more complex surgical and invasive procedures.
- Experience dealing with PPO and Managed Care insurance.
- Strong attention to detail and critical thinking skills. Ability to make decisions based on clinical knowledge/practices.
- Experience with a computerized healthcare information system required. Familiarity with fundamental Microsoft word software
- Excellent verbal and written communication skills.
- Demonstrates leadership abilities, judgment and supervisory skills in organizing work, assigning staff and making exceptions to policy.
Supervision Provided by this Position
- Supervises Authorization Specialists in the department.
Physical Demands
- The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
- Must have good balance and coordination.
- The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
- The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
- The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative.
Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.
Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.
Don’t See What
You’re Looking For?
Sign up for job alerts and we’ll notify you when new roles become available.
RegisterExplore the World of MLH
-
Career Areas at Methodist Le Bonheur Healthcare
Explore rewarding careers at Methodist Le Bonheur Healthcare. Discover nursing, allied health, and support roles with opportunities to grow and make a difference.
-
Benefits
Learn all about the great benefits that every member of our team is entitled to.
-
Our Culture
We’re committed to a community where everyone belongs and can make an impact.
-
Learning & Development
At Methodist Le Bonheur Healthcare, we want everyone to reach their highest and greatest potential. Our system is filled with a variety of roles that allow for upward and lateral mobility. We support career advancement and promote from within. And we provide many programs for career entry, education, training and advancement.
-
Our Locations
Get a closer look at the vibrant and historical city that we are proud to call home.
-
Contact Methodist Le Bonheur Healthcare
Reach out for support in your career search and application process.
-
Explore Memphis
Learn the advantages of living in Memphis.
-
CMS Test Page
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt.
-
-
-
Our Stories
A place to find all of our sites content in a filterable, browsable blog like homepage.
-
Nursing Careers at Methodist Le Bonheur Healthcare
Join a team of highly skilled, compassionate nurses empowered by advanced resources, ongoing education, and a supportive environment.
-
Methodist Le Bonheur Healthcare receives national honor for exceptional care
Methodist Le Bonheur Healthcare’s Memphis adult hospitals were ranked second in Tennessee and first in the Memphis metro area by U.S. News & World Report, with high-performing ratings across multiple specialties and procedures.
-
Methodist University Hospital Opens Neuroscience Institute Expansion
Methodist University Hospital opened a $2.8 million expansion of its Neuroscience Institute, adding 47 specialized rooms and enhanced academic and critical care capabilities to provide centralized, around-the-clock neurology and neurosurgery services.
-
Radiologic Technology Program Application Deadline Approaching
Methodist University Hospital is accepting applications for its Radiologic Technology Program through November 1, offering aspiring radiology professionals a limited-time opportunity to apply before the deadline closes.
-
Teamwork Powers Care Through Winter Storm
During severe winter weather in the Mid-South, employees at Methodist Le Bonheur Germantown Hospital went above and beyond, transporting one another through dangerous conditions to ensure uninterrupted care for their community.
Jobs for You
-
Surgical Technologist I PRN I Days I Germantown
- Germantown, Tennessee
- Surgical Services
-
Surgical Technologist I PT I Days I Germantown
- Germantown, Tennessee
- Surgical Services
-
Authorization Supervisor - FT days
- Nashville, Tennessee
- Prior Authorization
You have not viewed any jobs yet.
You have not saved any jobs yet.