Authorization and Referrals Supervisor

Description

Job Title:   Authorization and Referrals Supervisor 

Pay:           $25- $30 hourly

Type:          In-person

Location:  Tustin, CA

Openings: 1 Full-time

Position Purpose:   

The Authorizations and Referrals Supervisor plays a central role in the efficient and effective management of authorization and referral submissions and their subsequent follow-ups, covering a broad spectrum of insurance payers, including: Medicare, Medicaid, HMOs, and PPOs, as well as our uninsured patient population. This role is dedicated to ensuring the prompt resolution of assigned authorizations and referrals in strict adherence to our internal protocols and contractual health plan requirements. Moreover, it encompasses the equitable distribution of work among the Authorization Department Team, guaranteeing the timely submission and follow-up of authorizations and referrals, and serving as a vital communication link for insurance and procedural updates. In addition to these responsibilities, the Authorizations and Referrals Supervisor is instrumental in implementing, monitoring key performance indicators, and fostering staff engagement and development. Furthermore, they facilitate internal referrals to enhance patient services and cultivate a culture of continuous improvement.

FTOC’s Expectations of all Employees

· Adheres to all FTOC Policies and Procedures.

· Providing the upmost customer service experience to all clients

· Conducts self in a manner that always represents FTOC’s core values.

· Maintains a positive and respectful attitude with all work-related contacts.

· Communicates regularly with immediate supervisor about Departmental and FTOC concerns.

· Consistently reports to work as scheduled and in a timely manner prepared to perform the duties of the position.

· Meets productivity standards and performs duties as workload necessitates.

· Ability to train on all Learning Management Systems (LMS) by self-learning models from FTOC’s EMR. 

Core Duties and responsibilities, include but are not limited to:

1. Manage, provide oversight and      guidance to the Authorization Coordination team
2. Monitor and ensure compliance with work procedures and employee attendance
3. Assist in the hiring and training of staff, ensuring a strong understanding of      policies and services
4. Assess staff performance, providing coaching or corrective action as needed
5. Prepare performance reports as requested and set targets for improvement
6. Collaborate with leadership to develop scheduling parameters for various lines of      business
7. Proficiency with technology; EMR, Microsoft office, phone system, and other programs      as needed related to specific job functions
8. Exhibit excellent problem solving, leadership, and customer service skills
9. Coach team in de-escalations and warm handoff calls as necessary 
10. Optimize procedures, keep staff motivated, and engaged
11. Assist in implementation of contact center solution phone system, ensure all      pertinent systems are working properly and efficiently
12. Conduct daily morning huddles to update staff on policy changes and process flows
13. Assist in addressing a substantial volume of incoming inquiries promptly and in accordance with the regulatory timeliness standards of contracted health plans, as required
14. Develop team tasks and ensure daily tasks are completed
15. Communicate with others in a timely and professional manner within a reasonable timeframe for email, TEAMS, telephone, or other methods implemented by FTOC
16. Ability to prioritize and complete multiple tasks in a timely manner or specified deadlines
17. Educate clinic staff and patients about the rules, regulations, protocols, and timelines pertaining to specialty authorizations Assess and reconcile daily schedule
18. Protect patient rights by maintaining confidentiality of personal and financial information
19. Follow compliance rules and regulation against fraud and abuse
20. Work collaboratively with FTOC staff across various departments and specialties as needed
21. Attend mandatory meetings to remain well informed with the most current information
22. Perform additional duties, as assigned by Director/ Manager or FTOC leadership

*This job description in no way states or implies that these are the only duties to be performed by the employee. He or she will be required to follow any other instructions and to perform other duties, within scope, as assigned by his or her supervisor.

Teamwork and Interpersonal Skills:

· Displays an awareness of others' needs and consistently acts in their best interests.

· Exhibits courtesy, mutual respect, and compassion in all interactions with others.

· Takes initiative to propose constructive solutions to challenges.

· Recognizes and respects differences while actively seeking more effective communication approaches.

· Demonstrates a positive and professional response to changes and challenges.

· Nurtures positive working relationships and contributes to a collaborative work environment.

· Exhibits effective teamwork, working cohesively to support the organization in achieving its goals and objectives.

· Adapts smoothly to shifting workplace priorities.

Attends and actively participates in scheduled meetings, whether weekly, bi-weekly, or monthly

Education, Qualifications, and Experience:

· High School Diploma or equivalent (GED) required

· Bilingual: Spanish required

· Minimum 2 years of related experience 

· Must excel in multitasking within a high-paced environment

· Strong computer skills, acute attention to detail, confident and professional communication

· Responsiveness to the needs of both internal/external stakeholders in a professional and personable manner are expected

· Knowledgeable in general EMR/EHR systems is preferred

Work Schedule: 

•  FTOC is an in-person organization first, and foremost. Employees are expected to be on-site for their scheduled shifts.
• Employee schedules vary, depending on organizational, staffing, community, and patient needs. As such, FTOC may need to modify work schedules to meet such needs.
• Schedule Monday- Friday 9 AM - 5 PM. 
• Holidays and weekends may be required depending on an employee’s department due to organizational, staffing, community, and patient needs as FTOC continues to grow and expand work days and hours. 
• Overtime may also occur due to organizational, staffing, community, and patient needs.