Benefits Eligibility and Authorization Supervisor

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

📋 Description

• Manage and coordinate the day-to-day operations of the oncology authorization team.

• Oversee work queues, prioritize tasks, and monitor staff productivity.

• Supervise prior authorization, referral, and medical necessity processes for oncology and ancillary services.

• Examine escalated cases, denied authorizations, urgent treatment requests, and payer-related issues.

• Ensure that authorizations are secured, tracked, renewed, and extended as necessary.

• Collaborate effectively with physicians, advanced practice providers, nursing staff, pharmacy, scheduling, and financial counseling teams.

• Conduct daily meetings, provide staff coaching, and review workflows.

• Track authorization turnaround times, aging inventories, pending requests, and high-priority patient cases.

• Maintain a deep understanding of payer policies, medical necessity criteria, authorization standards, and regulatory updates.

• Analyze denials, determine root causes, and implement corrective measures.

• Execute quality audits to ensure authorization accuracy and compliance with documentation standards.

• Create and update standard operating procedures, training resources, and payer-specific workflows.

• Generate and assess operational reports related to approval rates, denial patterns, productivity, and turnaround times.

• Collaborate with Revenue Cycle, Patient Access, Managed Care, and Clinical Leadership teams.

• Foster staff development through training initiatives, performance management, mentoring, and competency evaluations.

• Ensure adherence to Medicare, Medicaid, commercial payer, IPA, and other regulatory requirements.

• Act as the primary contact for complex authorization issues, payer disputes, peer-to-peer reviews, and treatment access challenges.

• Lead initiatives aimed at continuous improvement to minimize treatment delays, enhance patient experiences, boost authorization approval rates, and reduce preventable denials.

⛳️ Requirements

• Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field is preferred.

• A minimum of five (5) years of experience in healthcare prior authorization, financial clearance, patient access, or revenue cycle is preferred.

• At least two (2) years of leadership, supervisory, or team lead experience in a healthcare environment is preferred.

• Strong preference for candidates with experience in oncology, infusion, radiation oncology, specialty pharmacy, or multi-specialty authorization.

• Broad knowledge of medical oncology treatment plans, radiation oncology services, imaging, genetic testing, surgical procedures, and specialty referrals.

• Solid understanding of Medicare, Medicaid, commercial payer, HMO, IPA, and delegated authorization standards.

• Proven experience in managing prior authorization workflows, referral management, medical necessity reviews, and payer compliance.

• Demonstrated ability to decrease authorization-related denials, treatment delays, and revenue risks through effective operational management.

• Experience in developing, monitoring, and reporting on operational KPIs, productivity metrics, quality audits, and performance dashboards.

• Strong analytical, problem-solving, and process enhancement abilities.

• Excellent leadership, coaching, performance management, and staff development skills.

• Ability to prioritize workloads in a fast-paced oncology environment with competing patient care and payer deadlines.

• Strong communication and relationship-building skills with physicians, clinical staff, executives, payers, and external partners.

• Proficient in electronic health records (EHRs), practice management systems, authorization platforms, Microsoft Excel, and reporting tools.

• A demonstrated commitment to compliance, regulatory standards, patient-centered care, and operational excellence.

• Preferred certifications include CRCR, CHAM, CPAR, CPC, or other credentials related to revenue cycle, reimbursement, or healthcare access.

🏝️ Benefits

• Medical, dental, and vision insurance coverage.

• Paid time off plan.

• Health savings account (HSA).

• 401k savings plan.

• Access to wages before payday through myFlexPay.

• Flexible spending accounts (FSAs).

• Short- and long-term disability insurance.

• Work-life resources.

• Paid parental leave.

• Healthy lifestyle programs.