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Prior Authorization Supervisor Jobs (NOW HIRING)

Saviance

Prior Authorization Specialist I

Boston, MA · On-site

$19.50 - $26/hr

Requests clinical information, outreaches to providers for missing information. • Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Supervisor, or ...

Regal Medical Group, Inc.

Provide direct supervisory oversight to prior authorization review nurses, professional claims review nurses, UM coordinators and UM compliance staff, including, but not limited to daily work ...

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Prior Authorization Supervisor information

How much does a precertification specialist make?

A precertification specialist typically earns between $40,000 and $55,000 annually, depending on experience, location, and employer. The role involves reviewing insurance requirements and coordinating approvals, often requiring familiarity with healthcare billing and authorization software.

What are the key skills and qualifications needed to thrive in the Prior Authorization Supervisor position, and why are they important?

To thrive as a Prior Authorization Supervisor, you need strong knowledge of healthcare benefit structures, prior authorization processes, and insurance guidelines, often supported by experience in medical administration or a related degree. Familiarity with healthcare management software, claims processing systems, and occasionally relevant certifications like Certified Medical Manager (CMM) or Certified Professional Coder (CPC) is important. Leadership, problem-solving abilities, and effective communication are essential soft skills for this supervisory role. These skills ensure efficient workflow, regulatory compliance, and positive team performance in a fast-paced healthcare environment.

How much does a prior authorization specialist make in the US?

A prior authorization specialist in the US typically earns between $40,000 and $55,000 annually, depending on experience, location, and employer. Salaries can vary based on certifications, such as Certified Medical Reimbursement Specialist (CMRS), and the complexity of the healthcare setting. The role often requires strong knowledge of insurance policies and medical billing software.

What is a Prior Authorization Supervisor job?

A Prior Authorization Supervisor oversees the prior authorization process in healthcare settings, ensuring that insurance approvals for medical treatments, procedures, or medications are obtained efficiently. They manage a team responsible for reviewing authorization requests, verifying coverage, and coordinating with patients, providers, and insurance companies. Their role includes training staff, monitoring workflow, and ensuring compliance with regulatory guidelines. Effective leadership and knowledge of insurance policies are key to success in this role.

What are the typical challenges faced by a Prior Authorization Supervisor, and how can someone succeed in this role?

One of the primary challenges for Prior Authorization Supervisors is balancing high-volume workflows while ensuring thorough reviews of complex insurance and medical documentation. Success in this role often involves staying updated on frequent policy changes, motivating team members, and developing effective communication channels between providers, payers, and patients. By implementing efficient processes and fostering a collaborative team environment, supervisors can reduce approval delays and improve overall service quality. Adaptability, attention to detail, and strong leadership skills are key to excelling and advancing in this field.

Is prior authorization a stressful job?

Prior Authorization Supervisors often find the role to be stressful due to the need to manage complex documentation, strict deadlines, and high volumes of requests. The job requires attention to detail, communication skills, and the ability to handle pressure, especially when dealing with urgent approvals or denials.

How to become a prior auth specialist?

To become a prior authorization specialist, candidates typically need a high school diploma or equivalent, along with experience in healthcare or insurance billing. Relevant skills include knowledge of medical terminology, insurance policies, and authorization processes, often supported by certifications such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS).
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Prior Authorization Supervisor jobs near you
Prior Authorization Specialist

Prior Authorization Specialist

Nationwide Children's Hospital

Columbus, OH • On-site

$16.75 - $22.50/hr

Other

Posted 6 days ago

Nationwide Children's Hospital rating

6.9

Company rating: 6.9 out of 10

Based on 129 frontline employees who took The Breakroom Quiz

523rd of 1,004 rated hospitals

Job description

Overview:
Schedule: M-F (Day shift, 40 hours per week)
This is a temporary position without guarantee of conversion to full-time employment.
Job Description Summary:
Coordinates patient accounts from prior authorization to point of bill payment or referral to collection, including processing billing for home health agencies to appropriate agencies, including Medicaid and self-pay. Maintains current knowledge of changes in billing requirements and regulations and assists in resolving billing problems.
Job Description:
Essential Functions:
  • Verifies patient insurance coverage and eligibility for homecare services.
  • Processes and submits insurance claims for reimbursement.
  • Communicates with patients, insurance companies, and healthcare providers to resolve billing issues.
  • Maintains accurate and up-to-date patient records and billing information.
  • Monitors and tracks outstanding claims and follows up on unpaid or denied claims.
  • Ensures compliance with all relevant regulations and guidelines related to homecare billing and reimbursement.
Education Requirement:
High School Diploma or equivalent, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
(not specified)
Experience:
  • Two years ofexperience billing public and private insurers for medical services using computerized billing system, required.
  • Homecare services experience, preferred.

Physical Requirements:
OCCASIONALLY: Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Standing, Walking
FREQUENTLY: (none specified)
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
Talking on the phone / in person Frequently (34 - 66%)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"

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About Nationwide Children's Hospital

Sourced by ZipRecruiter

Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Columbus, OH, US

Year founded

1892

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