Supervisor, Authorization and Benefits

Position Summary

The Authorizations & Benefits Supervisor is responsible for overseeing and managing the Authorization & Benefits team, ensuring that medical prior authorizations and benefits verification processes are handled efficiently and accurately. The role requires supervising the day-to-day operations of the department, leading and mentoring a team of specialists, and collaborating with other departments to streamline the authorization process. This role requires a results-driven, hands-on leader with strong people management skills who is passionate about process improvements. The supervisor will ensure compliance with insurance guidelines, optimize workflows, and address complex issues that arise in the authorization and benefits verification process. The position also requires ensuring a high level of customer service is maintained while working to resolve challenges in a timely and professional manner.

Key Duties and Responsibilities

The key duties and responsibilities of the Authorizations & Benefits Supervisor include, but are not limited to:

• Overseeing the daily operations of the Authorizations & Benefits team, ensuring that all tasks are performed accurately, efficiently, and in compliance with company standards and insurance requirements.
• Mentoring, coaching, and developing team members through regular training and performance feedback. Ensuring the team is equipped with the knowledge to handle complex prior authorization and benefits verification issues.
• Utilizing performance data to identify trends, access team effectiveness, and implement continuous improvement initiatives.
• Monitoring and analyzing workflows to ensure effective and timely processing of prior authorizations, benefits verification, and insurance claim follow-ups. Identifying opportunities for improvement and implementing process changes to enhance efficiency and accuracy.
• Ensuring the team stays current with insurance policies, healthcare plan requirements, and industry regulations. Fostering a culture of compliance with payer guidelines, HIPAA standards, and other regulatory requirements.
• Leading by example in providing excellent customer service, ensuring that patients, providers, and insurance companies receive timely and professional responses to inquiries regarding prior authorizations, coverage, and benefits.
• Addressing and resolving escalated issues related to authorizations, insurance denials, claims rejections, or complex patient inquiries. Providing guidance and support to team members when needed.
• Conducting regular audits to ensure accuracy in insurance verification and authorization processes.
• Tracking team performance and providing regular feedback to ensure goals and quality standards are met. Conducting audits to ensure accuracy in insurance verification and authorization processes.
• Working closely with other departments (e.g., billing, medical records, and patient services) to ensure smooth coordination and timely resolution of issues related to patient authorization and insurance benefits.
• Maintaining accurate records of authorization requests, denials, rejections, and other key metrics. Preparing regular reports for management on team performance, trends, and challenges.

Education/Experience

• High School diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• At least 5 years of experience in healthcare or insurance, with a focus on prior authorization, benefits verification, and accounts receivable processes
• At least 3 years of supervisory or leadership experience, preferably overseeing teams in prior authorization and benefits verification
• Previous supervisory experience or proven leadership ability in a healthcare setting is preferred
• Experience with Medicare, Medicaid, and commercial insurance plans required
• Knowledge of medical terminology and healthcare insurance processes

Knowledge, Skills and Abilities

• Strong leadership skills, including the ability to create a strategic vision for the department, motivate a team of specialists and foster a culture of innovation. Experience in providing constructive feedback and managing team performance.
• Excellent interpersonal skills, with the ability to work effectively with patients, healthcare providers, insurance companies, and internal teams. Ability to resolve escalated issues with professionalism and empathy.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment while maintaining attention to detail and quality.
• Experience in leading process improvement initiatives to enhance operational workflows, reduce errors, and improve processing times.
• Ability to identify issues, assess problems, and develop solutions quickly and effectively. Skilled at navigating complex insurance and authorization challenges.
• Understanding of and adherence to healthcare industry regulations, including HIPAA, OSHA, and payer guidelines.
• Proficient in using practice management systems, electronic medical records (EMR), and other healthcare software tools. Familiarity with insurance verification systems is a plus.
• Demonstrated change management skills, including successfully implementing new policies, procedures, or technology solutions while maintaining team morale.
• Ability to adapt to changes in healthcare policies, insurance guidelines, and organizational processes. Willingness to implement new approaches to improve efficiency and meet team goals.
• Strong written and verbal communication skills. Ability to communicate effectively with team members, management, and external stakeholders (e.g., insurance companies, patients).
• Self-motivated and able to work independently while collaborating as part of a team.
• Demonstrates patience and composure when dealing with challenging situations.
• Ability to handle sensitive and confidential information with discretion and professionalism.
• Willingness to step in and assist with team tasks when necessary to ensure smooth department operations.

Work Environment/Physical Demands

The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.