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Authorizations Manager Jobs

Company

SKYGEN USA
Address , Remote
Employment type FULL_TIME
Salary
Expires 2023-07-21
Posted at 11 months ago
Job Description
What will YOU be doing for us? Oversee all Authorizations staff members to ensure authorizations are processed timely and in accordance with plan limitations. Work collaboratively with other internal clinical resources to design framework by which clinical decisions are made to support plan limitations and medical necessity. Act as expert in the Authorizations Department by responding to a variety of client requests during the sales and implementation process.
What will YOU be working on every day?
  • Develop and implement appropriate training methods to ensure staff is provided with the appropriate tools to meet client requirements and objectives.
  • Identify, create, and coordinate workflow and efficiencies within the department.
  • Develop and utilize statistical techniques to evaluate trends and to manage staff performance to drive behaviors.
  • Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire by identifying necessary skills and core competencies for various roles, developing relevant interview questions to assess candidate knowledge, skill, and position fit with future growth and business objectives, and utilizing appropriate selection techniques.
  • Identify, develop and implement best practices to ensure improved efficiency, cost effectiveness, and that contractual requirements are met and/or exceeded.
  • Collaborate with Director of Third Party Administration - Claims/Clinical and Vice President of Operations on different strategic initiatives to better align the department for meeting organizational goals and objectives.
  • Maintain up to date knowledge on current clients including benefit and plan limitations.
  • Develop, and motivate staff. Initiate and communicate a variety of personnel actions including employment, termination, performance reviews, salary reviews, disciplinary actions, and development plans. Provide regular and behaviorally specific feedback to increase performance levels.
  • Foster an environment of continuous improvement though process and systematic efficiencies.
  • Act as an expert in the area of Authorizations by assisting in implementations, system presentations, Corrective Action Plan’s (CAP’s), Client contract reviews, Request for Proposals (RFP’s) and Utilization Review license renewal.
  • Update Director of Third Party Administration – Claims/Clinical on any significant issues in relation to clients.
  • Direct and oversee Authorizations Department within the organization to ensure all client requirements and organizational goals are met while also ensuring optimal performance and efficiency.
  • Possess an advanced understanding of all client requirements and convey expectations, changes and requirements to staff.
  • Work collaboratively with Dental Director and Chief Dental Officer in setting up algorithms, denial decision frameworks and other policies that guide overall review processes and decisions.
  • Ensure department is meeting appropriate quality standards through audits, appropriate controls, and review of practices and outcomes.
  • Participate in, or lead, various internal committees dedicated to quality, process improvement, and other organization wide initiatives.
  • Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
  • Foster an environment that focuses on ensuring integrity, respect, accountability, and superior service.
What qualifications do YOU need to have to be GOOD candidate?
  • 3 – 5 years of prior management experience.
  • 3 – 5 years of prior experience in the healthcare industry.
  • High school diploma or equivalent required.
  • Ability to use effective judgment and prior experience to troubleshoot common issues.
  • Ability to successfully lead and motivate teams.
  • Intermediate knowledge of Microsoft Office products (Word, Excel, and PowerPoint).
What qualifications do YOU need to have to be a GREAT candidate?
  • Knowledge of the Enterprise system.
  • Knowledge of common fraud, waste, and/or abuse techniques in the dental industry.
  • Previous dental office experience.
  • Previous experience working in a managed care organization or clinical management.
  • Knowledge of NCQA and URAC utilization management standards.
  • Knowledge of dental procedures, terminology, and CDT procedure coding.