Authorization Department Team Lead

Overview

Here at Lubbock IPA Management, we are changing the pain journey by treating every patient with an individualized care plan that is just as unique as they are. By reimagining what is needed, and implementing specialized groundbreaking technology, we deliver proven maximum effective results, with minimally invasive pain management procedures. At Lubbock IPA, we are committed to providing jobs that deliver opportunity and growth in a progressive, exciting, and fast-paced work environment.

We are committed to serving in fairness, dignity, and respect, and to providing an environment which affords opportunity and success. If you are looking for your next career opportunity, we have one waiting for you in Lubbock, TX!

Details: The Authorization Department Team Lead oversees the processing of all authorizations placed by Providers to medical carriers prior to patient’s clinical or surgical procedures while serving as a liaison between patients, insurance providers and our facility.

• Evaluate workload to determine what needs to be completed.
• Work with Practice Administrator to plan work priorities, obtain necessary supplies and assess skills needed to complete tasks.
• Assesses workload to plan work assignments.
• Collaborates with team members to discuss upcoming work assignments; delegates assignments based on team members skills and experience.
• Ensures work is completed safely, effectively and in a timely manner.
• Continually audits and reviews work performed by team members.
• Requests prior authorization for scheduled visits and procedures.
• Verifies health insurance eligibility, obtains benefit information and communicates findings with patients.
• Reviews clinical documentation to ensure it supports the insurance requirements for approval.
• Accurately notates the account with actions taken for prior authorization or additional information necessary.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification and prior authorization(s) for patients.
• Collaborates cross functionally with departments to provide account status updates in EMR, coordinate the resolution of issues and appeal denied authorizations.
• Follows up on pending authorization requests in a timely manner and notates all updates in EMR and shared tracker.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Notifies ordering providers if authorization/certification is denied.
• Consistently evaluates workflows and makes adjustments where necessary and/or communicates concerns regarding volume, workload, etc. to Practice Administrator with suggestions for improvement.
• Answers communication in timely manner from providers, patients and insurance companies related to authorization/pre-certification requests.
• Additional related duties as assigned.

• Previous knowledge/experience obtaining prior authorizations for surgical procedures.
• Familiarity with various insurance programs:
  Medicare, Medicaid, HMOs, Commercial payers.
• Strong, professional communication skills.
• Ability to type a minimum of fifty (50) words per minute.
• Positive attitude and adaptable to change.
• Strong internal and external customer service skills.
• Basic medical terminology.
• Knowledge of HIPAA and Patient Rights guidelines.
• Ability to follow all Federal, State and Local regulations.
• Ability to enter data professionally into the EMR system.
• Knowledge of CPT and ICD
  10 codes.
• High school or equivalent
• Insurance Pre-certification: 2 years (Preferred)
• CPT and ICD
  10 Code: 1 year (Preferred)

• Frequent sitting, writing, typing, and speaking
• Occasional standing, walking, reaching, bending, lifting, and carrying
• Lifting and carrying up to 25 pounds
• Frequent use of computer, keyboard, copy/fax machine, and phone
• Monday – Thursday 7:30 AM – 5:30 PM with 30 minute break. Hours may vary based on department and patient needs.
• Office setting.

• 3 Medical plans to choose from
• 2 Dental plans to choose from
• A Vision Plan
• Company-provided life and accidental death & dismemberment (AD&D) insurance.
• Options to increase Life and AD&D insurance for yourself and your family
• Short-Term Disability
• Long-Term Disability
• Freshbenies (Telemedicine, Behavioral Health and medical bill auditing and redirection of medical care via Advocacy)
• Bi-lingual is a plus.

We are an Equal Opportunity Employer EEO AA M/F/Vet/Disability. Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, protected veteran status or disability.