Lubbock IPA Management · 3 days ago
Authorization Department Team Lead
Lubbock, TX
Full-time
Onsite
Mid, Senior Level
2+ years expLubbock IPA Management is dedicated to transforming the pain management journey for patients through individualized care plans and advanced technology. The Authorization Department Team Lead is responsible for overseeing the authorization process for medical procedures, ensuring compliance with insurance requirements, and facilitating communication between patients and providers.
Hospital & Health Care
Responsibilities
Evaluate workload to determine what needs to be completed
Work with Practice Administrator to plan work priorities, obtain necessary supplies and assess skills needed to complete tasks
Assesses workload to plan work assignments
Collaborates with team members to discuss upcoming work assignments; delegates assignments based on team members skills and experience
Ensures work is completed safely, effectively and in a timely manner
Continually audits and reviews work performed by team members
Requests prior authorization for scheduled visits and procedures
Verifies health insurance eligibility, obtains benefit information and communicates findings with patients
Reviews clinical documentation to ensure it supports the insurance requirements for approval
Accurately notates the account with actions taken for prior authorization or additional information necessary
Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification and prior authorization(s) for patients
Collaborates cross functionally with departments to provide account status updates in EMR, coordinate the resolution of issues and appeal denied authorizations
Follows up on pending authorization requests in a timely manner and notates all updates in EMR and shared tracker
Ensures all services have prior authorizations and updates patients on their preauthorization status. Notifies ordering providers if authorization/certification is denied
Consistently evaluates workflows and makes adjustments where necessary and/or communicates concerns regarding volume, workload, etc. to Practice Administrator with suggestions for improvement
Answers communication in timely manner from providers, patients and insurance companies related to authorization/pre-certification requests
Additional related duties as assigned
Qualification
Required
Previous knowledge/experience obtaining prior authorizations for surgical procedures
Familiarity with various insurance programs: Medicare, Medicaid, HMOs, Commercial payers
Strong, professional communication skills
Ability to type a minimum of fifty (50) words per minute
Positive attitude and adaptable to change
Strong internal and external customer service skills
Basic medical terminology
Knowledge of HIPAA and Patient Rights guidelines
Ability to follow all Federal, State and Local regulations
Ability to enter data professionally into the EMR system
Knowledge of CPT and ICD10 codes
High school or equivalent
Preferred
Insurance Pre-certification: 2 years
CPT and ICD10 Code: 1 year
Benefits
3 Medical plans to choose from
2 Dental plans to choose from
A Vision Plan
Company-provided life and accidental death & dismemberment (AD&D) insurance.
Options to increase Life and AD&D insurance for yourself and your family
Short-Term Disability
Long-Term Disability
Freshbenies (Telemedicine, Behavioral Health and medical bill auditing and redirection of medical care via Advocacy)
Company
Lubbock IPA Management
11-50 employeesFunding
Current Stage
Early StageCompany data provided by crunchbase