Authorization Supervisor

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Oversee and coordinate the work activities of Authorization Specialists.

• Provide direction, support, and guidance to the department and its staff.

• Supervise the daily operations and processes within the pre-certification department.

• Assist team members in implementing policies and procedures to enhance departmental efficiency.

• Monitor the volume of diagnostic and surgical procedures to ensure efficient precertification.

• Support associates with intricate pre-certification cases, ensuring adherence to protocols and maximizing reimbursements.

• Collaborate with payers to resolve technical issues and communicate changes that impact reimbursement and precertifications.

• Coordinate provider documentation to assess medical necessity, appropriateness, and procedural efficiency.

• Foster relationships with physicians, office staff, patients, and other healthcare team members.

• Plan and schedule work, allocate assignments, and ensure sufficient staffing levels.

• Evaluate associate performance, clarify expectations, assist with goal setting, and encourage teamwork.

• Recruit, assess, counsel, train, take corrective action, and recommend promotions or terminations of department personnel.

• Develop and execute orientation, training, and educational processes.

• Participate in preparing the capital budget, monitor and authorize expenditures, and assist in cost control and operational improvements.

• Exemplify behavior aligned with MLH Mission, Vision, and Values.

⛳️ Requirements

• Technical degree or diploma in nursing is required.

• 5–7 years of experience in authorization or denial management.

• 5–7 years of clinical nursing experience.

• 5–7 years of experience in precertification.

• Current Licensed Practical Nurse license in Tennessee from the Tennessee Board of Nursing is mandatory.

• Proficient in Microsoft Office, including Word and Excel.

• Extensive understanding of insurance coverage practices, terminology, referrals, authorization/pre-certification, Medicare, and secondary payer regulations.

• Experience with pre-certification and/or CPT medical codes.

• Proven analytical skills to collect and interpret insurance and contract information.

• Clinical knowledge necessary for managing complex surgical and invasive procedure precertifications.

• Familiarity with PPO and Managed Care insurance.

• Strong attention to detail and critical thinking abilities.

• Experience utilizing a computerized healthcare information system.

• Excellent verbal and written communication capabilities.

• Demonstrated leadership, judgment, and supervisory skills.

• Good balance and coordination.

• Ability to perform light work, lifting up to 25 lbs. occasionally and/or up to 10 lbs. frequently.

• Close visual acuity for data and figure analysis, transcription, computer terminal viewing, and extensive reading.

🏝️ Benefits

• An employer of choice with a talent-rich environment where Associates can advance their careers.

• A culture embodied by the Power of One.

• A dedication to the highest standards of care and unity.

• Low cost of living in Memphis.