PruittHealth

JOB SUMMARY:

Manages and oversees the Insurance and Authorization team to ensure accurate insurance verification, timely authorization processing, and compliance with payer requirements for the Agency's home health patients. Responsible for staff performance, workflow standardization, payer oversight, and cross functional collaboration to prevent care delays, billing holds, and revenue leakage.

KEY RESPONSIBILITIES:

1. Provides direct oversight and management of the Insurance and Authorization team, including daily operations, workload distribution, and performance monitoring.

2. Recruits, trains, coaches, and evaluates Insurance and Authorization staff to ensure competency and accountability.

3. Establishes productivity and quality expectations and conducts routine performance reviews.

4. Develops standardized workflows, job aids, and procedures for insurance verification and authorization processes.

5. Ensures initial and ongoing authorizations are obtained timely to support uninterrupted patient care.

6. Monitors authorization expirations, visit limits, and renewal requirements and directs staff follow up accordingly.

7. Maintains visibility into daily work queues and resolves escalated authorization or payer issues.

8. Collaborates with clinical leadership to ensure accuracy of services requested for authorization.

9. Maintains up to date knowledge of payer contracts, coverage policies, and authorization rules and educates staff on changes.

10. Reviews authorization related denials, trends, and staff performance metrics and implements corrective action plans.

11. Works closely with billing and AR teams to resolve authorization related claim issues and denials.

12. Develops and monitors team KPls including turnaround times, approval rates, denial rates, and workload volumes.

13. Supports audits, payer reviews, and documentation requests related to insurance and authorization activities.

14. Maintains complete confidentiality with personnel, patient, and financial information to which you are privileged.

15. Supports the Agency's customer service reputation by promoting and maintaining a responsive, knowledgeable, and professional approach to all internal and external contacts.

MINIMUM EDUCATION REQUIRED:

• Bachelor's degree preferred or equivalent combination of education and experience.

MINIMUM EXPERIENCE REQUIRED:

• Minimum three to five years' experience in insurance verification and authorization within a home health or healthcare setting.
• Minimum two years of supervisory or people management experience required.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

N/A

ADDITIONAL QUALIFICATIONS:

• Strong knowledge of Medicare, Medicare Advantage, Medicaid, and commercial payer authorization requirements.
• Working knowledge of home health revenue cycle workflows and payer contracts.
• Proficiency with electronic medical record systems and payer portals.
• Strong leadership, organizational, coaching, and problem-solving skills.
• Ability to communicate effectively with staff, clinical leadership, and external payer representatives.
• Ability to sit for extended periods of time.
• Regular attendance is a requirement of this position.

Must be able to read, write, and speak the English language

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

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