Supervisor, Authorizations

Job Description

Job Description

Professional Authorization Operations
o Supervise authorization workflows for professional services, including surgeries, office procedures, injections,
imaging, and other services within the team's assigned scope.
o Ensure staff verify eligibility, benefits, referral requirements, and payer authorization requirements after
submission.
o Confirm requests include the correct provider, procedure and diagnosis codes, service location, dates of service,
and required clinical documentation.
o Monitor submissions, pending requests, approvals, denials, and cases where authorization is not required; ensure
status and supporting information are documented in designated systems.
o Ensure changes to procedures, providers, locations, or dates of service are reviewed for authorization updates.
o Coordinate requests for additional clinical information, peer-to-peer reviews, reconsiderations, and appeals with
the appropriate clinical and revenue cycle teams.
o Escalate unresolved cases and barriers according to departmental timelines, with clear ownership and next steps.
• Facility Authorization Support
o Assist facility authorization staff with assigned workloads, coverage needs, urgent requests, and complex cases.
o Help verify that facility approvals match the scheduled service, facility, dates, and requested level of care, as
applicable.
o Coordinate professional and facility authorization requirements and track each approval separately when required.
o Identify gaps between scheduled services and authorization records and work with the responsible teams to
resolve them.
o Communicate unresolved facility authorization concerns to the facility authorization manager. Follow established
escalation and cancellation processes.
• Team Leadership and Accountability
o Assign daily work based on service dates, urgency, complexity, staffing, and queue volume.
o Monitor productivity, quality, attendance, and completion of assigned work; address concerns promptly and
consistently.
o Provide onboarding, written training plans, cross-training, coaching, and ongoing education.
o Conduct regular team huddles and individual check-ins to review priorities, barriers, and performance.
o Complete quality audits, share findings, and follow up on corrective actions.
o Reinforce departmental workflows, communication expectations, escalation procedures, and accurate
documentation.
o Support performance evaluations and corrective action in collaboration with the manager and Human Resources.
• Performance and Process Improvement
o Review daily authorization queues and identify unstarted cases, aging requests, approaching service dates, and
unresolved denials.
o Maintain required dashboards, metric sheets, and pending-case reports.
o Track authorization timeliness, accuracy, productivity, denial trends, and authorization-related delays or
cancellations.
o Investigate recurring authorization errors and implement improvements within the supervisor's authority.
o Report trends, staffing concerns, and unresolved operational barriers to the manager with recommended actions.
o Partner with scheduling, clinical teams, admitting, coding, billing, and follow-up staff to prevent authorization
related reimbursement issues.
o Maintain awareness of payer requirements and communicate relevant workflow changes to staff.
• Confidentiality and Professional Standards
o Protect patient information and follow organizational privacy, security, and compliance policies.
o Maintain complete, accurate records of payer communications and authorization decisions.
o Recognize that authorization does not guarantee payment and escalate documentation or coverage concerns to
the appropriate team.
o Perform other related duties as assigned.
EDUCATION
• High school diploma or equivalent.
• Associate or bachelor's degree in healthcare administration, business, or a related field preferred.
EXPERIENCE
• At least three years of experience in prior authorizations, insurance verification, or a related revenue cycle function,
including professional authorization experience.
• At least one year of supervisory, team lead, or comparable experience directing work and training staff.
• Working knowledge of payer authorization processes, medical terminology, CPT/HCPCS and ICD-10 codes, and clinical documentation requirements.
• Experience using electronic medical records, practice management systems, payer portals, and authorization tracking tools.
• Strong organizational, communication, problem-solving, and coaching skills.
• Ability to manage competing priorities, resolve issues, and hold staff accountable for timely, accurate work.
Preferred:
• Experience in orthopedic, spine, surgical, or other specialty authorizations.
• Experience supporting hospital or ambulatory surgery center authorizations.
• Familiarity with Athena, THRIVE, SIS, or comparable systems.
• Experience with authorization denials, appeals, quality audits, and operational reporting.
REQUIREMENTS
• Hybrid leadership position with remote and onsite responsibilities
• Travel required based on operational and organizational needs
• Must maintain availability during West Coast business hours
• Ability to perform in a fast-paced orthopedic and surgical environment
• Requires flexibility to support operational needs, escalations, and urgent patient care situations as they arise
KNOWLEDGE
• Knowledge of healthcare authorization and precertification processes, payer requirements, and medical necessity
guidelines.
• Knowledge of documentation standards and requirements needed to support authorization approvals.
• Knowledge of referral, scheduling, and revenue cycle workflows and their impact on patient access and reimbursement.
• Knowledge of regulatory, compliance, and organizational policies related to authorization activities.
• Knowledge of denial trends, escalation protocols, and authorization risk mitigation practices
SKILLS
• Skilled in preparing and submitting accurate, complete, and timely authorization requests.
• Strong attention to detail to ensure documentation accuracy and completeness.
• Skill in prioritizing workloads and managing multiple authorization requests within established deadlines.
• Skill in identifying potential barriers to approval and proactively escalating cases to prevent delays.
• Strong analytical and problem-solving skills to reduce preventable denials and authorization-related cancellations.
• Effective communication and collaboration skills to coordinate with providers, clinical staff, payers, and facility teams.
• Ability to monitor productivity and quality metrics and maintain performance standards in a fast-paced environment.
ABILITIES
• Ability to consistently meet departmental turnaround-time expectations for authorization processing.
• Ability to evaluate authorization requests and supporting documentation for completeness and compliance.
• Ability to recognize issues that may delay approval and take appropriate action to resolve or escalate concerns.
• Ability to support strategies that reduce preventable denials, treatment delays, and canceled services.
• Ability to maintain a high level of accuracy while managing competing priorities and deadlines.
• Ability to provide reliable authorization support across facilities, departments, and stakeholders.
• Ability to build and maintain productive working relationships that support efficient patient care and operational
effectiveness.
• Ability to adapt to changing payer requirements, processes, and organizational priorities while maintaining service
excellence
ENVIRONMENTAL WORKING CONDITIONS
• Hybrid leadership position with remote and onsite responsibilities
• Travel required based on operational and organizational needs
• Must maintain availability during West Coast business hours
• Fast-paced orthopedic and surgical environment
• Requires flexibility to support operational needs, escalations, and urgent patient care situations as they arise
PHYSICAL/MENTAL DEMANDS
• Candidates must be comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.