"Supervisor, YM Centralized Prior Authorization"

Overview

This position reports to the Manager of Yale Medicine Centralized Prior Authorization.

Supervises the day-to-day activities of the staff, including management of Time and Attendance, Time Off Requests, Assignment of Work Priorities, Quality and Assurance Reviews. Manage the daily operations of the staff and oversee, monitor, and delegate work for all related functions of the unit to ensure that specific procedures are closely followed. Provide oversight to all staff in all operational functions. Keep staff informed of all insurance carrier regulatory and procedural changes pertinent to every category of their job function. Hold regular team meetings with staff and provide continuous updates to the management team on issues impacting the day-to-day activities. Provide expert recommendations to enhance efficiency and productivity, leveraging comprehensive knowledge of EPIC, managed care requirements, and regulations governing authorizations and referrals. Implement new or revised corrective measures across various disciplines as needed. Identify needs for quality assurance reporting to link productivity and goal attainment throughout the central office; work with decision support systems representative to design effective reports and tools using available data in EPIC or other related data management systems. Evaluate trends in productivity and respond with innovative solutions to meet changing needs. Identify, review, and evaluate existing HR and operations procedures and processes and develop consistent practices across the departments. Recommend additional training, develop performance standards, and monitor progress on a regular basis as goals and objectives are obtained. Implement disciplinary action, resolve workplace problems through formal and informal methods, represent department in second and third step grievances. Evaluate and identify work priorities for each section; develop back-up systems to meet operational needs during crisis or limited staffing times. Develop specific, working job descriptions to accurately define accountability, job functions, competencies, and scope of both exempt and non-exempt staff. Review, evaluate and recommend cross-training strategies to reduce turnover and improve overall employee satisfaction. Maintain statistics from the units’ work activities to provide regular productivity reporting and feedback to management and staff. Measure volume of work and projected needs; make recommendations for improvement overall performance and productivity of unit. Develop and update job descriptions. Response for the interviewing and hiring of staff within the department. Development specific training programs and protocol, along with consistent quality assurance monitoring and review. Special projects assigned related to the operational needs of the central business office.

Required Skills and Abilities

1. Proven leadership skills. Demonstrated managerial, decision-making, planning, and organizational skills.
2. Excellent written and oral communication skills; ability to adapt communication styles.
3. High degree of tact, diplomacy and understanding in dealing with insurance carriers, patients, and staff.
4. Ability to perform in a high volume, multiple priority environment.
5. Strong supervisory, organization and analytical skills. Working knowledge of medical billing systems ( EPIC) and Microsoft applications including Work, Excel, and PowerPoint.

Preferred Skills and Abilities

1. At least three years of operational experience in Prior Authorization and Professional Billing or an equivalent combination of education and experience.
2. Knowledge of Governmental and Third-Party Medical insurance regulatory and procedural requirements; medical terminologies and ICD and CPT coding.
3. EPIC Professional Billing Experience and knowledge of insurance carrier authorization/referral requirements.

Principal Responsibilities

1. Supervises the day-to-day activities of support staff.
2. Assesses and resolves or escalates problems arising within unit.
3. Assists in the development of policies and procedures in support of unit.
4. Assists in planning for work unit needs.
5. Participates in unit budget planning.
6. Evaluates work requests to determine if they are appropriate to the unit or another area.
7. Ensures that work flow is organized and staffed for quality efficient completion.
8. Communicates deadlines and special circumstances to staff.
9. Maintains equipment and supplies for unit.
10. Completes evaluations of direct report employees.
11. Interacts with University personnel to define work assignments and requirements and communicate progress of work.
12. Interacts with external sources to coordinate work necessary to fulfill projects, keep abreast of new products and technologies, or arrange for subcontractors.
13. Supervises a staff of exempt and non-exempt employees.
14. Performs other duties as assigned.

Required Education and Experience

Bachelor’s Degree in related field and two years of experience or an equivalent combination of education and experience.

Salary Range

$61,500.00 - $91,875.00

Location

221 Whitney Ave, New Haven, Connecticut