Supervisor, Authorization Technician

Job Summary

The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.

This position provides but is not limited to:
Supervision for Authorization Technicians Leads, Authorization Technician and clerical staff in the UM department.
Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.
Conduct 1.1 monthly sessions with staff to review performance.
Consistently track staff performance, and work with individuals to improve performance as needed.
Create, review, and administer corrective action forms. 
Responsible for hiring, training, motivating, evaluating and counseling of assigned Associate Supervisors, Leads, and Representatives.  
Ensure that Associates, Supervisors, Leads, and Representatives provide efficient and courteous service. 
Oversee overtime work and will produce accurate accounting of each representative work performance. 
Conducting evaluations of and implementing enhancements to the day-to-day operations of the unit.
Aid with product launches and expansions.
Execute tracking, and assessing member satisfaction efforts and identifying potential areas of the unit dissatisfaction and opportunities for improvement.
Facilitating the development, review, and revision, as appropriate, of organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines.
Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.

This position collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.

In addition, this position performs Supervisory roles including payroll, employee Paid Time-Off (PTO) time management, supporting the Leads providing direction and support. The Supervisor authorizes request consistent with auto authorization criteria,  maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers.  The position supervises all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. 
 

Duties

Supervision of day to day activities of Authorization Technicians, including but not limited to: Providing direction, Monitoring of staff performance and skillsets for consistency and improvement for all lines of business, Handling all questions/issues raised by staff, Developing tools and procedures on training for staff, Recommending process improvement processes, Preparing and analyzing call center statistical reports, Monitoring of skillsets for consistency, Ensuring quantity/quality is met for overtime, Ensure that all  comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: Diagnosis (DX) codes, Current Procedural Terminology (CPT) ,Healthcare Common Procedure Coding System (HCPCs) codes.

Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements.

Computer Input: Accurately and completely processing referrals/authorizations in the MHC system.  And distributing a complete file  to UM Specialist. Within 2 hours of receipt Identify duplicate requests using the claims and CSIM system to verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system.  Appropriately documenting what information was used in making this determination.  Within 4 hours of receipt: Appropriate identification and timely notification of time sensitive requests: Appropriately identifying for the staff which you support; request that are priority based on date of receipt and established TAT criteria for compliance.

Accurate Filing/Maintenance of confidential member information. Creating secure, complete files.

Assist in the preparation of  communication for authorization determinations, including, but not limited to preparing  template letters for members and providers (authorization approval, denial, deferral, modification and pay/education).

Duties Continued

Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing).

Support UM Committee and Audit activity via  Department performance reporting. Assures the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames.

Employee training and development within all core systems. New employee orientation to the departments structure and work flow assignments. The Supervisor will support performance standards and develop performance improvement plans. 

Monitoring policies and procedures including but not limited to time and attendance, monthly incentive and monthly performance audits 

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 2 years in Medi-Cal managed supervisory experience in a health plan/health insurance authorization processes and/or as a Medical Assistant.

At least 1 year of lead (process, program, or staff)/supervisory experience.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Preferred: 

Experience in working with the disadvantaged population, seniors, or people with chronic conditions or disabilities. Medi-Cal, Healthy Families, Healthy Kids and Medicare background preferred.

Skills

Required:

Strong verbal and written communication skills.

Proficient with Microsoft Word, Excel, and Access.

Excellent organizational, interpersonal and time management skills.

Must be detail-oriented and an enthusiastic team player.

Demonstrate proficiency in data entry and processing of referrals/authorizations in the system.

Knowledge of medical terminology and ICD-10 and CPT codes.

Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements such as submitting requested information in a timely manner. Also to use the approved Authorization Request form with complete medical information i.e.: DX codes, CPT, HCPC codes.

Preferred:
Knowledge of MHC and CSIIM computer system.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information