Supervisor – Benefits Eligibility and Authorization

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

📋 Description

• Oversee and coordinate the daily functions of the oncology authorization team.

• Monitor work queues, prioritize assignments, and manage team productivity.

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

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

• Ensure timely acquisition, tracking, renewal, or extension of authorizations to prevent treatment delays.

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

• Conduct daily huddles, offer staff coaching, and review workflows.

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

• Maintain up-to-date knowledge of payer policies, medical necessity requirements, authorization guidelines, and regulatory changes.

• Analyze authorization-related denials, identify root causes, and implement corrective measures.

• Perform quality audits to ensure accuracy in authorizations, documentation compliance, and policy adherence.

• Develop and update standard operating procedures, training materials, and payer-specific workflows.

• Generate and assess operational reports on approval rates, denial trends, productivity, and turnaround times.

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

• Facilitate staff development through training, performance management, mentoring, and competency assessments.

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

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

• Drive continuous improvement efforts to minimize treatment delays, enhance patient experience, increase 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.

• Experience in oncology, infusion, radiation oncology, specialty pharmacy, or multi-specialty authorization is strongly preferred.

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

• In-depth understanding of Medicare, Medicaid, commercial payer, HMO, IPA, and delegated authorization requirements.

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

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

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

• Strong analytical, problem-solving, and process improvement capabilities.

• Excellent leadership, coaching, performance management, and employee development abilities.

• Capability to prioritize workload 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.

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

• Commitment to compliance, regulatory requirements, patient-centered care, and operational excellence.

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

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off plan.

• Health savings account (HSA).

• 401k savings plan.

• Access to wages before payday with myFlexPay.

• Flexible spending accounts (FSAs).

• Short- and long-term disability coverage.

• Work-Life resources.

• Paid parental leave.

• Healthy lifestyle programs.