Overview

Manages, monitors and coordinates the day-to-day non-clinical authorization operations activities, including development and monitoring of internal processes, coordinating activities between the clinical and non-clinical staff, and managing support functions to facilitate efficient non-clinical authorization operations. Makes recommendations on operational improvements for the department. Works under general direction.

Responsibilities
• Manages the day-to-day operations of the Authorization Operations Department. Oversees the development, utilization, and evaluation of internal processes to ensure customer satisfaction, efficient operations, and accurate and timely resolution for all complaints and issues. • Implements and manages workflow procedures and systems for an efficient and timely operation that is responsive to customers (members, caregivers, providers) and operational needs. Troubleshoots difficult customer service issues, facilitates problem resolution and directs staff in addressing and resolving day-to-day operational issues. • Assists management team in the development of long and short -range objectives for department, which includes system and operational rollouts and coordination of non-clinical support functions. • Provides input to the Education and Quality department regarding training needs for new initiatives. Participates in the overall planning, implementation and evaluation of such programs. Provides training to staff as needed. • Works with management to develop and implement strategies and actions to improve the quality of the team’s performance, which includes participation in workflow reengineering, process improvement, risk mitigation and computer application development activities. • Monitors adherence to regulatory and enterprise standards to ensure compliant operations and department’s readiness for internal and external audits • Analyzes business operations, , utilization and schedules; contributes to systems design and implementation; and develops standards to measure, maintain and maximize efficiencies and meet operational needs. • Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development budget, and hire, promotes, and terminates staff and recommends salary actions as appropriate, as well as maintains business continuity preparedness and contingency planning for the department. • Participates in special projects and performs other duties as assigned.
Qualifications
Education:
Bachelor's Degree in Business, Healthcare or other related industry, or the equivalent combination of work and experience required

Work Experience:
Minimum five years progressive management experience, preferably in a customer service or health care environment required Proficient in Personal Computers applications, including Microsoft Word and Excel required Knowledge of medical terminology, and /or insurance terminology required Strong knowledge of operations of manual and automated office systems and procedures required Strong knowledge of third-party payer requirement for reimbursement preferred Strong operational skills with attention to detail required