POSITION SUMMARY

The Prior Authorization Supervisor is responsible for overseeing the operations of the prior authorization department, ensuring compliance with payer guidelines, and managing staff. This role focuses on optimizing workflows, training team members, and ensuring the department meets performance standards.

ESSENTIAL FUNCTIONS

Supervises and supports the prior authorization team leads and specialists.
Develops and implements departmental policies and procedures to ensure operational efficiency.
Oversees staff performance, conducting regular performance reviews and providing feedback.
Ensures compliance with payer guidelines and regulatory requirements.
Collaborates with other departments, such as billing and clinical services, to address issues and optimize workflows.
Handles escalated issues, appeals, and disputes related to prior authorizations.
Monitors and audits team performance and ensures that authorization requests are processed in a timely manner.
Trains and onboards new team members assuring they have all resources needed to be successful in their roles.
Manages escalated issues and work with payers and providers to resolve complex cases.
Ensures team compliance with internal policies and payer regulations.
Processes the most complex prior authorization cases including high-cost medications and procedures.
Collaborates with clinical teams on cases requiring additional medical documentation.
Leads process improvement efforts to enhance authorization workflows.
Handles appeals for denied authorizations and follow up with payers for resolution.
Serves as a point of contact for escalated authorization issues.
Assists in reviewing insurance policies to ensure compliance with payer requirements.
Coordinates with healthcare providers and insurance companies to resolve discrepancies.
Ensures timely submission and follow-up on authorization requests.
Maintains accurate records and documentation of all authorization activities.
Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
Maintains accurate and detailed notes in the company system.
Adapts quickly to frequent process changes and improvements.
Is reliable, engaged, and provides feedback to improve processes and policies.
Attends all department, team, and weekly company meetings as required.
Appropriately routes incoming calls when necessary.
Meets company quality standards.
Embraces and exemplifies Cardinal Health values:
Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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Operations Supervisor (Prior Authorization - US Healthcare account)

POSITION SUMMARY

ESSENTIAL FUNCTIONS

Supervises and supports the prior authorization team leads and specialists.

Develops and implements departmental policies and procedures to ensure operational efficiency.

Oversees staff performance, conducting regular performance reviews and providing feedback.

Ensures compliance with payer guidelines and regulatory requirements.

Collaborates with other departments, such as billing and clinical services, to address issues and optimize workflows.

Handles escalated issues, appeals, and disputes related to prior authorizations.

Monitors and audits team performance and ensures that authorization requests are processed in a timely manner.

Trains and onboards new team members assuring they have all resources needed to be successful in their roles.

Manages escalated issues and work with payers and providers to resolve complex cases.

Ensures team compliance with internal policies and payer regulations.

Processes the most complex prior authorization cases including high-cost medications and procedures.

Collaborates with clinical teams on cases requiring additional medical documentation.

Leads process improvement efforts to enhance authorization workflows.

Handles appeals for denied authorizations and follow up with payers for resolution.

Serves as a point of contact for escalated authorization issues.

Assists in reviewing insurance policies to ensure compliance with payer requirements.

Coordinates with healthcare providers and insurance companies to resolve discrepancies.

Ensures timely submission and follow-up on authorization requests.

Maintains accurate records and documentation of all authorization activities.

Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.

Maintains accurate and detailed notes in the company system.

Adapts quickly to frequent process changes and improvements.

Is reliable, engaged, and provides feedback to improve processes and policies.

Attends all department, team, and weekly company meetings as required.

Appropriately routes incoming calls when necessary.

Meets company quality standards.

Embraces and exemplifies Cardinal Health values:

Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others