Authorization Manager

Retina-Vitreous Associates Medical Group; California; On-site; USD 70,000 - 95,000; Full time

Job summary

Retina-Vitreous Associates Medical Group in California seeks an Authorization Manager to oversee the workflow of the Authorizations Department for eligibilities, authorizations and referrals.

You will review and optimize the prior authorization process for services and medications, supervise on-site and virtual staff, ensure timely approvals, and maintain compliance with insurer requirements in a fast-paced, high-volume ophthalmology practice.

Qualifications

• High school diploma or GED required.
• Medical Assistant Certification preferred.
• 1+ year of demonstrated skills in a similar position in a medical practice with 300+ daily patients.
• Ability to work in a fast-paced, high-volume environment with changing information.
• Knowledge of third-party payer rules and regulations preferred.
• Well organized and able to multi-task quickly and effectively.
• Ability to handle high volume.

Responsibilities

• Develop and maintain Authorization Department policies and procedures.
• Maintain accurate information on accepted insurance plans.
• Maintain accurate records of all prior authorization requests, documenting approvals and denials.
• Communicate with insurance carriers, tracking updates and changes to requirements.
• Plan, assign, monitor, and appraise department staff job results.
• Manage time to maintain productivity and reorganize work activities when priorities change.
• Establish objectives and monitor progress related to department goals.
• Maintain, train, and evaluate staff on all processes and procedures.
• Ensure that authorizations are in place prior to patients’ appointments.
• Assist Credentialing and Authorizations staff to prevent backlog.
• Collaborate with other departments to improve day-to-day efficiencies.
• Clearly articulate operation problems and contribute to solutions.
• Adhere to patient care standards and regulatory requirements.

Skills

Communication

Multi-tasking

Attention to detail

Fast-paced environment

Policy adherence

Education

High School Diploma or GED

Medical Assistant Certification

Job description

Job Description

Job Description

Job Title:

Authorization Manager

FSLA Status:

Exempt

Dept:

PFS

Schedule:

Full-Time

Location:

On Site

Working Conditions and Physical Requirements

• § Frequently adjusts or moves items weighing up to 50lbs across office for various needs.
• § The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.
• § Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, computer, phone.
• § The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
• § Constantly remaining in a stationary position. Standing or Sitting for Prolonged Periods
• § Must be able to wear personal protective equipment, such as KN95 masks most of the day
• § Works Overtime and on Weekends as needed
• § Must have Sufficient Ambulatory ability to move to various locations.

Education and or Experience Requirements

• § High School Diploma or GED
• § Medical Assistant Certification (Preferred)
• § One Year or More of Demonstrated Skills in similar position in a Medical practice with 300+ daily patients volume
• § Must be able to work in a fast pace, high volume environment in which information is constantly changing
• § Knowledge of third party payer rules and regulations preferred
• § Well organized and able to multi-task quickly and effectively
• § Ability to handle high volume

Job Summary and Objectives

The Authorizations Manager will oversee the workflow of the Authorizations Department, related to eligibilities, authorizations and referrals for all medical services provided to RVAMG patients. The Authorization Manager will review and assess prior authorization request process for medical services, procedures, and medications making sure that all assigned Authorizations are resolved within appropriate time restraints. This position involves managing the verification of patients’ insurance benefits and eligibility through comprehensive intake processes. The Authorizations Manager will monitor all departmental processes, ensuring and tracking department’s efficiency and productivity. The Authorization Manager will review and develop processes to maintain timeliness standards, follow clinical requirements and medical necessity for patient’s care. The Authorization Manager oversees a team on site and a virtual team.

Core Responsibilities

• § Develop and maintain Authorization Department policies and procedures.
• § Maintain accurate information on accepted insurance plans.
• § Maintain accurate records of all prior authorization requests, documenting approvals and denials ensuring the security and integrity of sensitive provider information.
• § Communicate with insurance carriers, tracking updates and changes to prior authorization and medical necessity requirements.
• § Plan, assign, monitor, and appraise department staff’ job results.
• § Manage time to maintain productivity, reorganize work activities when setbacks or priority changes are encountered.
• § Establish clear objectives and measurements, monitor staffs’ progress and results related to department goals and organizational initiatives.
• § Maintain, train, and evaluate staff on all processes and procedures in place.
• § Ensure that work completed by staff is timely, accurate and complete per policy and procedure, all authorizations are in place prior to patients’ appointments.
• § Assist Credentialing and Authorizations Department staff by resolving any issues to prevent backlog.
• § Assist and work with other departments’ management in implementing changes or additions to policies and procedures to improve day-to-day efficiencies.
• § Clearly articulate operation problems and positively contribute to solution development process.
• § Adhere to all patient care, departmental standards, policies, procedures, and meet regulatory requirements on a consistent basis.

Company Description

One of the Nations Leading Medical Groups specializing in the treatment of diseases affecting the retina, the