Job Title: Pre-Certification Supervisor
Reports To: Revenue Cycle Manager, Coding and Finance
Location: Northwest or North-Central Arkansas Depending on the position, employees may be asked to move locations from time to time based on clinic and patient needs.
FLSA: Exempt/Salaried
Job Summary:
The Pre-Certification Supervisor has oversight of Pre-Certification Analyst for imaging, infusion (Chemo), PT/OT, Surgery/VA, and outside orders. The Pre-Certification Analyst completes forms online or on paper; retrieves and submits records as needed to obtain authorizations. Works with patients, insurance companies, and clinical staff members.
Supervisory Responsibilities (if applicable):
Keep the Pre-Certification team up to date with training, department changes, etc. Develop, implement, and maintain department policies and procedures. Identify and initiate updates or new policies or procedures. Train new employees and provide guidance on workflows and processes. Conduct all employee evaluations (RCM available to join, if needed). Supervise and correct timecards as needed, as well as any PTO requests for the Pre-Certification team.
Job Duties / Responsibilities: Including, but not limited to, the following:
Review of imaging schedules for Benton County Clinic, North Hills Clinic, and Parkway Clinic daily to determine the insurances that require prior authorization for imaging. Answers and resolves incoming calls regarding STAT requests. Prompt obtainment of authorization(s) for any urgent add-on requests Maintain accurate and current authorization(s) information in OncoEMR and g4. Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with specific insurance plans. Work closely with the insurance verification team to ensure insurance coverage is up to date. Maintain a professional relationship with physician/nurses addressing questions, concerns regarding imaging orders/diagnoses. Set up peer-to-peer review as requested. Maintain a good working relationship with outside referring providers and staff. Maintain patient/clinic confidentiality. Ability to cover positions for Outside Treatments/Genetic Testing/In-patient Authorizations, as designated. Maintain pleasant/helpful attitude towards patients and staff. Perform all related duties as required by the Revenue Cycle Manager(s), Business Office Director, CFO, and CEO.