Prior Authorization Supervisor

Description

eBlu Solutions was founded in 2012 to help specialty medical practices manage the complex workflow associated with high-cost infusion and injection treatments. Simply put, our solution gets patients to treatment faster.

JOB SUMMARY

The Prior Authorization Supervisor is responsible for leading, mentoring, and motivating the team, tracking the client’s prior authorization status through completion. This role will ensure the team accurately processes requests according to regulatory and client-specific guidelines. This position reports to the Manager of Payer and Authorization Services.

Note: After a 60-day evaluation period, eligibility for a hybrid work schedule with 2 required in-office days per week may be granted.

Requirements

KEY RESPONSIBILITIES

•  Maintain the highest level of patient confidentiality
•  Can manage day-to-day responsibilities independently
•  Provide the highest level of customer service when representing eBlu
•  Understands and adheres to the eBlu Guarantee of a turnaround time of 8 hours for Sponsored Drugs
•  Oversees continued follow-up for cases submitted by eBlu or the provider in accordance with the SOP
•  Process documents based on department guidelines per standards and performance indicators.
•  Recommend process improvements based on data insights and team feedback
• Ability to review and create the Standards of Procedure documentation
• Utilizes and helps create all resources or tools i.e., Payer Notes, Google, Caller Guide, etc
• Actively listens to calls in Ring Central to identify training opportunities or to gather important information from the call
• Provides prompt communication to internal teams for updated Payer information
• Ability to investigate call sheets in Review Completed status
• Review updates and changes communicated in Microsoft Teams chats in a timely manner
• Support providers through secure messaging while maintaining professional verbiage
• Manage prior authorization activity queues related to the position
• Provides timely communication throughout the prior authorization process
• Act as the first point of contact for resolving team or client-related issues, ensuring timely and satisfactory resolutions
• Support training enrichment of new or prospective team members
• Evaluate team performance metrics, ensuring quality and productivity standards are maintained
• Ensuring tasks are scheduled and assigned appropriately to meet demands
• Oversee and guide team members, ensuring tasks are completed efficiently and effectively while fostering a positive work environment
• Conduct regular team meetings to communicate objectives, share updates, and foster a collaborative environment
• Bi-monthly meetings scheduled by Supervisor
• Manage the reciprocal relationship between staff and the organization
• Ability to provide support to peers and new associates
• Identifies and coaches the development of staff to support career growth
• May provide additional shoulder to shoulder time as needed with team members
• Active participation in 1:1s with staff members providing feedback
• Weekly 1:1 with all team members during ramp-up period
• Bi-weekly 1:1 with team members not meeting expectations or as requested
• Monthly 1:1 with team members meeting expectations
• This model does not apply to team members needing additional support or team members that have requested additional 1:1 time
• Enters journal entries within 24 hours of team members scheduled 1:1
• Adheres to and monitors staff adherence to the eBlu attendance policy
• Provides 24 hours' notice for any personal time off
• Recognizes group discrepancies and escalates when needed
• Acts as a Subject Matter Expert to assist with automation and enhancements with Dev
• Provides additional support as requested for BI discrepancies
• Provides support for escalated cases and works with the proper department
• Supports testing development changes in the eBlu System as requested by the Manager
• Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner.
• Understanding of the Availity chat to Save and upload to Microsoft Teams Channels as needed
• Understanding of the initiation process for authorizations to Payers via portal, fax or phone
• Occasionally makes outbound calls to Insurance Payers and/or Specialty Pharmacies to obtain patient benefits and authorization information
• Accurately interprets notes on the call sheet provided by the senior or Supervisor before outreach
• Completes call sheets completely and accurately
• Understands and completes Prior Authorization calls within the In Process queue
• Other duties and responsibilities as assigned by the manager based on the specific client contract

EXPERIENCE, SKILLS & QUALIFICATIONS

EDUCATION

• High School Diploma or GED required
• Bachelor's degree preferred or equivalent work experience

EXPERIENCE

• 3-5 years’ experience in a health plan, facility, healthcare provider office, or pharmaceutical industry required
• Experience working with insurance companies and extensive knowledge of different types of coverage and policies required
• Experience with pre-certification or pre-authorization required
• 3-5 years’ experience in a call center preferred
• Knowledge of medical terminology preferred
• Working knowledge of drug reimbursement issues preferred
• Understanding of health plan medical policies and prior authorization criteria
• Knowledge of HCPCS, CPT, and ICD-10 coding

SKILLS

• Must have excellent multitasking skills to allow for success in the role
• Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
• Must be very detail-oriented and organized to maintain accurate patient insurance records
• Ability to focus and work quickly within a 24-hour turnaround for patient insurance information
• Strong communication and interpersonal skills
• Ability to work and resolve issues independently and collaboratively in a team environment
• Proactive and able to take initiative in driving projects forward
• Ability to follow instructions
• Strong computer skills; preferably Microsoft Word or Excel software applications
• Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
• Ability to manage multiple priorities concurrently

PHYSICAL & TECHNICAL ENVIRONMENT

• Ability to work at a desk in the office for long periods
• Noise level in the work environment is moderate
• Specific vision abilities required by this job include close vision and color vision
• Ability to maintain focus under high levels of pressure/multiple priorities

BENEFITS

• Competitive pay and performance-based incentives
• Comprehensive health, dental, and vision insurance
• Retirement savings plan with company matching
• Flexible schedules with both remote and hybrid work options
• Professional development and growth opportunities
• Generous paid time off and holiday schedule

EBLU SOLUTIONS IS AN EQUAL OPPORTUNITY EMPLOYER - eBlu Solutions seeks talent from all backgrounds to bring diversity of

thought, agility, and capability to our organization. We promote a working environment where all employees are treated and rewarded fairly. We do not tolerate any form of discrimination that adversely affects individuals or groups based on national origin, race, color, religion, sex, gender, sexual orientation, marital status, disability, age, or any other legally protected aspect of a person’s identity.