Supervisor Hospital Authorization - Nemours

The Hospital Authorization Department Supervisor oversees all inpatient and outpatient hospital-based authorizations, including Pharmacy, Transports, offsite physician authorizations, assigned physician-based authorizations, and Advanced Delivery program. They provide direct support, and supervise Authorization Specialists I, II, Lead; and the Preadmission Specialist. The Supervisor will monitor assigned work queues to ensure rules are satisfied to complete authorization or release pended charges and adjustments. Monthly audits, financial estimate creation, and performance management goals are monitored, with results shared with associates. When areas of improvement are identified, the Supervisor will collaborate with Manager along with outside departments and their leadership. The Supervisor is a working Supervisor who covers all authorization types, participates in organizational committees, attend payor meetings, and demonstrates advanced knowledge of Epic to perform daily functions. The position assists and guides Leads with associate training. Responsibilities also include monitoring workflows to improve quality and ensure associates are meeting productivity requirements. As appropriate, the Supervisor will contact the insurance company to dispute a denial, discuss a peer to peer, and discuss benefits with families. The Supervisor provides continuous quality improvement by monitoring/adjusting workflows, identifying opportunities, suggesting improvements, and initiating implementation of new services to authorize. The Supervisor acts as a change agent who encourages alternative approaches and new ideas.

This is primarily remote position with some in-office reporting as directed.

Reviews the number of days out daily to enter in activity file.

Answer financial and billing questions with families. Ability to create a financial cost estimate and ensure staff complies with the No Surprise Billing Act.

Perform audits to ensure auth/cert and referral shells are properly documented in addition to perform reviews for staff to follow proper authorization processes are followed.

Provide daily support to the department staff. Assign and organize coverage for associate time off coverage. Perform authorization and preadmission duties as needed including assigned workqueues.

Monitor associate's workload for timely submission of authorizations and that workqueues are handled as expected to prevent delay in service and/or denials.

Collaborate with Manager on interviewing, onboarding, offboarding, and coordinates new hire training. Complete 90-day assessment, inform Manager on a new associate's performance.

Complete associate's yearly evaluations and determine associates merit increase in collaboration with Manager. Addresses performance and/or behavioral concerns.

Identify workflow improvement opportunity and implement changes

Manage time off requests, track attendance, and Kronos timekeeper

Working with manager on department policies and procedures to support Nemours Strategic Plan, continuous improvement, and maintain compliance with regulatory requirements.

Current CRCR (Certified Revenue Cycle Representative) Required

More than 10 years authorization experience required. Lead, Sr. or Supervisor Experience required.

Revenue Cycle Related certification preferred