Med Auth & Access Operations Lead

Beth Israel Lahey Health; United States; On-site; USD 79,000 - 110,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Pharmacy Ambulatory Supervisor to lead the Specialty Pharmacy Liaison referral team at BIDMC. You will oversee day-to-day operations, ensure efficient workflows, and supervise staff while handling select patient cases in ambulatory clinics.

You will partner with the Director of Pharmacy Ambulatory Services on projects, training, and program management, driving performance, quality, and compliance across Medicare/Medicaid processes and HIPAA requirements in a

Qualifications

• 3–5 years related work experience in medication authorization.
• Strong understanding of data & analytics.
• Understanding insurance and adjudication processes; knowledge of 3rd party insurance plans and required PA forms.
• Experience with computer systems including web-based applications and Microsoft Office (Outlook, Word, Excel, PowerPoint, or Access).

Responsibilities

• Assists with day-to-day operations including scheduling and coverage of operations (essential)
• Assists with the employee(s) oversight and works closely with leadership to meet departmental goals and performance. (essential)
• Monitors and provide reporting on key performance indicators and meet with staff on a routine basis to have performance discussions (essential)
• Plans, reviews and optimizes workflows ensuring maximization of efficiencies. Ensures the proper workflow and intakes distribution through departments, and schedules and delegates workload amongst team members. (essential)
• Ensures employee training and quality of work through development of training materials, administration of training and continuous quality control. (essential)
• Ensures consistent communication with staff, patients and providers to ensure proper and timely renewal of authorizations and referrals. (essential)
• Manages direct reports' workload to effectively manage, audit and verify team members' work to ensure information accuracy and productivity. (essential)
• Monitors situations for fraud, waste, and abuse of Medicare/Medicaid benefits and reinforces HIPAA and PHI protocols. (essential)
• Has the authority to direct and support employees daily work activities. Has the direct responsibility to undertake the following employment actions: hiring, termination, corrective action and performance reviews.

Skills

Medication authorization

Data analytics

Insurance adjudication

MS Office

Web-based applications

Outlook

Word

Excel

PowerPoint

Access

Education

Associates or Bachelor’s degree

Tools

Microsoft Office suite

Job description

Beth Israel Lahey Health is seeking a Pharmacy Ambulatory Supervisor to lead the Specialty Pharmacy Liaison referral team at BIDMC. You will oversee day-to-day operations, ensure efficient workflows, and supervise staff while handling select patient cases in ambulatory clinics.

You will partner with the Director of Pharmacy Ambulatory Services on projects, training, and program management, driving performance, quality, and compliance across Medicare/Medicaid processes and HIPAA requirements in a