Northern Maine Medical Center
Referral and Authorization Supervisor
Northern Maine Medical Center, Fort Kent, Maine, us, 04743
JOB SUMMARY:
The Referral & Authorization Supervisor is responsible for overseeing the centralized referral and prior authorization teams while actively performing key duties within both areas. This role ensures the seamless operation of referral coordination and prior authorization processes, maintaining compliance with organizational and payer requirements. The supervisor acts as a resource for team members, promotes exceptional patient care, and supports the overall goals of Northern Maine Medical Center.
ESSENTIAL FUNCTIONS:
* Manage day-to-day operations of the referral and prior authorization teams, ensuring efficient workflows and high-quality service. * Serve as a liaison between patients, providers, and payers to facilitate smooth communication and coordination of care. * Train, mentor, and evaluate team members, fostering professional growth and ensuring adherence to organizational policies and procedures. * Monitor and assign work queues, ensuring timely processing of referrals and authorizations. * Assist in processing referrals and prior authorizations, including: *
Reviewing medical records to extract pertinent clinical information. * Obtaining prior authorizations in accordance with payer requirements. * Communicating with patients to provide updates and gather necessary information.
* Maintain accurate records and documentation within the electronic medical record (EMR) system, ensuring compliance with HIPAA regulations. * Identify and address barriers to efficient operations, recommending and implementing process improvements. * Stay up to date with changes in payer policies, EMR updates, and industry best practices. * Collaborate with other departments to ensure accurate and timely sharing of information. * Protect patient privacy and confidentiality, maintaining a professional and courteous demeanor at all times. * Perform additional duties as assigned, supporting the goals of Northern Maine Medical Center.
EDUCATION, TRAINING AND EXPERIENCE:
* Bachelor's degree in healthcare, business administration, or a related field with relevant experience; or an Associate's degree with significant additional experience in a healthcare setting. * Minimum of two years of experience in healthcare settings, with responsibilities in referrals and/or prior authorizations. * Previous supervisory experience strongly preferred. * Proficiency in medical terminology and healthcare insurance processes. * Experience with electronic medical records (EMR) systems.
WORKER TRAITS:
* Strong leadership and interpersonal skills, with the ability to inspire and guide a team. * Exceptional organizational and time-management skills, with the ability to prioritize and multitask effectively. * High level of attention to detail and accuracy. * Excellent verbal and written communication skills. * Ability to maintain composure in high-pressure situations. * Self-motivated and able to work independently as well as collaboratively. * Commitment to continuous learning and professional development.
The Referral & Authorization Supervisor is responsible for overseeing the centralized referral and prior authorization teams while actively performing key duties within both areas. This role ensures the seamless operation of referral coordination and prior authorization processes, maintaining compliance with organizational and payer requirements. The supervisor acts as a resource for team members, promotes exceptional patient care, and supports the overall goals of Northern Maine Medical Center.
ESSENTIAL FUNCTIONS:
* Manage day-to-day operations of the referral and prior authorization teams, ensuring efficient workflows and high-quality service. * Serve as a liaison between patients, providers, and payers to facilitate smooth communication and coordination of care. * Train, mentor, and evaluate team members, fostering professional growth and ensuring adherence to organizational policies and procedures. * Monitor and assign work queues, ensuring timely processing of referrals and authorizations. * Assist in processing referrals and prior authorizations, including: *
Reviewing medical records to extract pertinent clinical information. * Obtaining prior authorizations in accordance with payer requirements. * Communicating with patients to provide updates and gather necessary information.
* Maintain accurate records and documentation within the electronic medical record (EMR) system, ensuring compliance with HIPAA regulations. * Identify and address barriers to efficient operations, recommending and implementing process improvements. * Stay up to date with changes in payer policies, EMR updates, and industry best practices. * Collaborate with other departments to ensure accurate and timely sharing of information. * Protect patient privacy and confidentiality, maintaining a professional and courteous demeanor at all times. * Perform additional duties as assigned, supporting the goals of Northern Maine Medical Center.
EDUCATION, TRAINING AND EXPERIENCE:
* Bachelor's degree in healthcare, business administration, or a related field with relevant experience; or an Associate's degree with significant additional experience in a healthcare setting. * Minimum of two years of experience in healthcare settings, with responsibilities in referrals and/or prior authorizations. * Previous supervisory experience strongly preferred. * Proficiency in medical terminology and healthcare insurance processes. * Experience with electronic medical records (EMR) systems.
WORKER TRAITS:
* Strong leadership and interpersonal skills, with the ability to inspire and guide a team. * Exceptional organizational and time-management skills, with the ability to prioritize and multitask effectively. * High level of attention to detail and accuracy. * Excellent verbal and written communication skills. * Ability to maintain composure in high-pressure situations. * Self-motivated and able to work independently as well as collaboratively. * Commitment to continuous learning and professional development.