Manager, Network Authorization Company: NorthEast Provider Solutions Inc. City/State: Valhalla, NY Category: Executive/Management Department: Clinical Care Mgmt-WMC Health Union: No Position: Full Time Hours: M-F 9-5p Shift: Day Req #: 42296 Posted Date: Feb 20, 2025 Hiring Range: $74,647 - $94,490 Apply Now External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/28649) Internal Applicant link Job Details: Job Summary: Manager, Network Authorization manages the day to day activities of the Network Authorization Specialists teams, ensuring adherence to payer protocols and policies to prevent denials or delay in patient’s receipt of authorization for hospital admission or for other services as needed. The incumbent supervises the management of payer requests for clinical reviews and other information and acts as liaison with payer’s clinical staff, hospital case management staff, and department or registration team when required. The Manager, Network Authorization also oversees, audits, and performs a variety of clerical functions in support of case management network department and social work staff. Responsibilities: + Manages the day to day operations of the network prior authorization specialists’ team. Plans and directs work flow and project assignments. + Oversees the network prior authorization volume and workload to ensure service standards are met. Conducts hiring, training and evaluation of staff. Including annual staff apparels. + Assists in the development of policies and procedures for network authorization activities. Recognizes and recommends operational improvements. + Assigns and oversee the work of Authorization Specialists in the Case Management Department. + Trains Authorization Specialists team and work schedules. + Ensures the maintenance of detailed records and files to consistent with detailed and accurate documentation as required. + Implements procedures and systems to ensure timely procurement of documentation and authorizations for patient treatments and care. + Resolves problems or issues presented by Authorization Specialists regarding difficult or complex cases. + Obtains accurate benefits information for inpatient admissions approval and collects demographic and insurance data, ensuring the accuracy and completeness of the information. + Researches, follows up, and resolves open and pending requests in a timely manner to prevent denials and ensure authorizations are obtained. + Transmits patient clinical data and functions as clinical coordinator in communicating directly with payer to ensure that all information required by payer for approval and authorization of patient care is submitted. + Enters payer requests for clinical review into care management system and tasks case managers for additional information required by payer. + Serves as liaison between payer, case management, and the department or registration team. + Follows daily admit, transfers and discharge stats to verify authorizations are accurate and completed, and communicates with case managers, hospital personnel, and external agencies when required. + Responds to and assists in resolving denials and submitting appeals, distributes denial letters, maintains denials in patient account binders, and manages denial volume to send to appeals. Reviews encounter lists daily for accuracy and updates location and clinical information in care management system. + Prepares reports for Finance Department to ensure maximum reimbursement where home care is the discharge disposition, and interfaces with the home care agency to review the initial plan of care and ensure it was executed within the three-day post discharge timeframe. + Assists and educates all members of the network team regarding processes and payer requirements. Reviews end of day reports for distribution to case managers and social workers as needed. Prepares and/or reviews a variety of reports, including reports on discharge dispositions, staffing ratios, and volumes managed. + Train and assist network clinical care managers on the use of payor portals for accuracy of authorization require for post-acute care. + Serve as the payor portal super user for access to payor portals as required. + Performs a variety of office clerical functions, such as typing correspondence, letters and reports, opening and distributing mail, answering telephones and distributing messages appropriately, managing staff calendars, and maintaining time and leave records and staff files. + Keeps abreast of changes in specialized requirement, eligibility criteria, data requirements, and internal procedures, and ensures communication of these changes to staff. + Manages UKG time keeping for case management department. Include work schedules. + Serve as the case management liaison and human resources department for the process of medical leave request and return to work paper work process. + Meet with all new hires for introduction of the departmental requirements. Qualifications/Requirements: Experience: + 3-5 years of experience providing administrative support, processing health care insurance authorizations for inpatients in or for an acute care hospital, health care facility, or hospital insurance plan for case management and/or utilization review activities, required. + 2 years of experience in a supervisory role, required Education: + Associates Degree, required. + Satisfactory completion of 30 credits* toward a Bachelor’s degree may be substituted on a year for year basis for up to four years of the required experience. There is no substitution for the specialized experience involving acute care authorizations. Licenses / Certifications: N/A Other: Thorough knowledge of the processes and protocols of the revenue cycle, managed care and commercial health care insurers regarding authorizations and certification; good knowledge of medical terminology and procedural codes, and medical records; working knowledge patient billing and patient accounts and of the levels of care that patients are discharged to; working knowledge in the use of the automated care management system; ability to perform data entry quickly and accurately; ability to communicate effectively with clinical professionals and administrative staff, a variety of personnel, ability to work in a fast paced environment; ability to organize work efficiently and meet deadlines; ability to train and supervise the work of subordinate employees. Special Requirements: Education beyond the secondary level must be from an institution recognized or accredited by the Board of Regents of the New York State Education Department as a post-secondary, degree-granting institution. About Us: NorthEast Provider Solutions Inc. Benefits: We offer a comprehensive compensation and benefits package that includes: + Health Insurance + Dental + Vision + Retirement Savings Plan + Flexible Savings Account + Paid Time Off + Holidays + Tuition Reimbursement Apply Now External Applicant link (https://pm.healthcaresource.com/cs/wmc1/#/preApply/28649) Internal Applicant link Talent Community Search Jobs Hiring Events (https://wmchealthjobs.org/job-events-list/)