Summit Health Inc | Authorization Supervisor | jersey ...

About Our Company We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care. Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians. When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care. Job Description The Authorization Supervisor, in coordination with the department manager, is responsible for planning, organizing, and supervising the daily operations of the Authorization Department. The supervisor ensures that authorizations are processed in a timely manner, health plan protocols are followed, and authorization information is communicated to clinical staff, physicians, and patients. The supervisor must have a keen understanding of basic insurance concepts, and health plan policies. The supervisor will ensure that staff is aware of current health plan policies and is trained in all system requirements. Essential Job functions: Provides leadership and support in problem solving within the Authorization Department, serving as a role model and consultant for the staff. Assists in interpreting policies & procedures Demonstrates the ability to make decisions and delegates responsibility to assure high quality performance and efficiency of the team Assists with management functions such as providing feedback on performance reviews, assistance with payroll, variance reports, and other daily operational functions. Provides feedback to the manager Supervises and monitors the workflows for the internal team and our vendor partners Monitors the reports and dashboards to ensure that authorizations and referrals are completed in a timely manner Researches and corrects claims on Hold or denied for authorization and referral documentation Documents and provides education when changes or updates are made to the health plans' authorization policies Facilitates the submission of claims by ensuring that data is accurately recorded in Athena according to SMG workflows All other related activities that lead to the successful adjudication of a claim Identifies staff training requirements to ensure complete system knowledge, efficient processing of authorizations, and adherence to department workflows and reports deficiencies to manager Plans and assists in the training of new hires to ensure they can demonstrate proficiency in Athena Collector and department workflows Demonstrates the ability to identify, analyze and resolve problems independently, and communicate outcomes effectively to manager Consults and communicates with physicians, staff, and patients in a way that is professional, supports the SMG customer service standards, and demonstrates subject knowledge Demonstrates knowledge of the health plans' authorization and billing guidelines to ensure maximized reimbursement of claims Reviews the medical record to supply documentation to support medical necessity and clinical policy guidelines, manages appeals and peer to peer reviews for denied authorizations Demonstrates knowledge of the healthcare industry regarding the revenue cycle, authorizations, and NJ state insurance laws. Runs regular meetings with the team, addresses workflow issues, and reports to the manager Ensures that department work is prioritized on a daily basis and reassigns resources as appropriate Completes draft of yearly staff evaluations for manager's approval and assists the manager in presentation to the evaluation to the employees Monitors departmental compliance with all applicable standards (SMG policy, HIPAA, and OSHA). Reports compliance concerns to the manager and ensures resolution of the issues Specific Job Requirements: Minimum of 2 years' experience in Radiology/Imaging authorization processing Expertise in Athena Collector co-sourcing model Expertise in research and resolution of authorization items in Athena Hold Buckets Expertise in Athena Reporting, Excel spreadsheets, Microsoft Word and data locations available under the user's security access General Job Requirements: Keen understanding of generally accepted insurance benefit terms and processes Excellent Communication Skills: Patient notes/Claim edit notes/Appointment notes, Physician and office staff, Manager/Director, Payers Expertise in Quick view, Insurance, Case Policy, Authorizations and Outgoing Referrals, all screens, tools, and data locations available under the user's security access Establish and maintain a positive work environment Ability to works as a team member demonstrating respect for individuals and supports the goals of the team, co-workers, managers, and physicians Excellent customer service skills and ability to consistently provide the highest level of customer service with patients, co-workers and other SMG departments Co-ordinates with other supervisors and teams within the Revenue Cycle Department and the offices to ensure that authorizations are processed in a timely manner Ensures that staff manages EHR documentation appropriately, passwords are in order, and all other HIPAA guidelines are followed in the department Physical Job Requirements: Physical agility, which includes ability to maneuver body while in place Dexterity of hands and fingers Endurance (e.g. continuous typing, prolonged standing/bending, walking) Environmental Risks: Allergens: dust, mold and/or pollen Combative Patients / Visitors Education, Certification, Computer and Training Requirements: Bachelor's Degree or work-related equivalent 2-4 of work experience with medical insurance, preferably physician billing, expediting insurance referrals and pre-certifications, or claim adjudication. Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) Preferred. Experience Standard Office Technology in a Window based environment & Microsoft Office Suite Required. About Our Commitment Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, or file a complaint at

Created: 2024-11-28