Team Leader of Authorization and Referral Management

Team Leader of Authorization and Referral Management

Under the supervision of the Manager of Insurance Authorization and Follow-up, the Team Leader of Authorization and Referral Management is responsible for the day-to-day leadership of insurance authorization staff and referral coordination staff.

Core Duties :

• Responsible for the daily management of the Insurance Authorization Unit (IAU), Referral Coordination including daily assignment of work and follow-up on staff questions.
• Ensure that the Insurance Authorization Unit meets or exceeds productivity targets, and consistently secures authorizations for the full breadth and scope of services, including Inpatient / Observation, Diagnostic Imaging, Pharmaceutical (Infusion), Radiation Therapy and Surgical. Also responsible for working with the team to ensure speedy follow-up on denials or retro-authorization requests.
• Responsible for ensuring team secures insurance referrals for all inbound South County Medical Group patient encounters.
• Acts as the primary on-site insurance authorization subject matter expert for the ancillary departments to referring providers offices, insurance carriers, as well as patients.
• As needed, researches payer rules and requirements as it relates to referrals or authorizations.
• Collaborate with Case Management and UR department to secure inpatient or observation authorization as appropriate. If denied by the payer, working with UR to appeal the payer decisions where appropriate.
• In collaboration with the Manager of Insurance Authorization and Follow-Up, responsible for following up on referral and authorization-related denials to minimize impact on accounts receivable

Other Duties :

Minimum Qualifications :

Required Certifications, Licensure :

Preferred Qualifications / Additional Skills :

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