Medical Authorization Operations Lead

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

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.