Operations Supervisor - Authorization

Join our dynamic team and make a meaningful impact in the healthcare industry. You'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix!

Experience these exceptional benefits when you join Med-Metrix!

• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

JOB SUMMARY

The Operations Supervisor, Authorization is responsible for the supervision and oversight of global staff and policies & procedures, and working closely with the Manager, Provider Enrollment to ensure the credentialing/enrolling of new and established health care providers and other policies/procedures of the department are being followed.

MAJOR RESPONSIBILITIES

·        Oversee issue resolution for the provider education process regarding application completion and submission

·        Oversee and ensure that the collection, updating and maintenance of necessary provider information and documentation is completed

·        Oversee and ensure that the enrollment follow-up, by client and payer, is completed within departmental and client parameters

·        Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner

·        Ensure verification of provider and group information with insurance companies is completed

·        Ensure that the information for enrollment and termination of all providers is accurate and communicate to team and clients as appropriate.

·        Implement and maintain client and Company Q/A standards and protocols and coordinate with department manager quarterly reporting of same

·        Act as the point of contact to the client to troubleshoot any issues and escalate as needed to management

·        Contribute to the departmental process and procedures with a collaborative approach

·        Monitor mPower and other provider reports to ensure they are kept current and report any deficiencies in same

·        Assist in the training and education on enrollment processes or required research for accuracy, ensuring that all training activities are complete and up to date

·        Document and record training sessions to be used for future reference

·        Monitor and analyze productivity along with performing Q/A for all staff

·        Provide timely feedback to offshore provider enrollment regarding Q/A process and results

·        Identify struggles with Provider Enrollment staff and provide guidance when needed globally

·        Performs other duties as requested

·        Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

·        Understand and comply with Information

·        Security and HIPAA policies and procedures at all times

·        Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

QUALIFICATIONS

• High school diploma or equivalent required
• Leadership experience of at least 2 years
• Minimum 5 years’ experience in Provider Enrollment required
• Knowledge of and experience in healthcare billing preferred
• Experience with CAQH required
• Microsoft Office Suite knowledge/use required
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions:

• Work Schedule: US Hours 9AM - 5PM EST
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.