PHRN Team Leader

Responsibilities Prioritize incoming authorization and referral requests according to queue urgency Review patient’s clinical and chart documentation related to the service submitted by the provider’s office Obtain and/or follow up on authorization and referral requests from the patient’s payer through any of the following methods—depending on the payer’s policy:Perform outbound calls to payer’s authorization department Access payer’s authorization online portal Submit faxes to payer’s authorization department Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests Obtain and/or follow up payer’s peer-to-peer review requirements and send them back to provider’s office for the actual initiation Cater inbound calls from payers and perform necessary actions required for the task Listen and review voicemail messages from payers then perform necessary actions required for the task Monitor activities of Nurses to assess schedule adherence, accuracy, quality, productivity, timeliness and compliance with job requirements, policies and procedures. Report updates to management. Provide basic on-the-job training for direct reports and serve as a resource to address questions related to the policies, processes and procedures. Monitor, identify and resolve performance/behavior/attendance issues using prescribed performance management techniques. Adhere to all company policies and procedures. Adjust to the needs of meeting service level agreements under supervision of Manager. Ensure training needs of team members are met. Successfully complete all client related training and keep record of the same. Hold team briefings on a daily basis with the team. Communicate all process and client changes to direct reports within specific timelines and keep record of such updates. Act as a single point of contact for the assigned team members for all their job related needs and create a harmonious work environment. Escalate performance related issues with respect to assigned team members to Managers on a timely manner (PIP). Responsible for day-to-day functional supervision of work group, including work assignment and attendance monitoring; providing input into selecting, training, developing, and completing performance appraisal of work group(s) in accordance with the organization’s policies and applicable compliance requirements. Employee separations to be handled in-line with company policies and HR Required Skills Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes Comprehensive understanding of Medical Terminology Prior experience in processing multispecialty authorizations including contact with payers 2 years experience of acute hospital experience Experience in prior authorization process Experience with general computer software (Internet, Word, Outlook, PDF required) Proficiency to learn new software programs quickly Excellent customer service skills: communicates clearly and effectively Excellent verbal and written communication skills Professional and effective interaction skills with co-workers, clients, providers, and vendors Proven ability to work well individually and as a team member Strong attention to detail Ability to follow company and account-specific standard operating procedures and policies Ability to adapt to constantly changing environment Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand Ability to remain organized with multiple interruptions Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies Ability to comfortably receive constructive feedback Required Experience Graduate of Bachelor of Science in Nursing with active PH registered nurse license 1–2 years of experience of US healthcare authorization busine Total of 2-5 years of experience in the BPO/Healthcare industry is an advantage Bachelor's Degree in Nursing with active PH Registered Nurse license Minimum 2 years of Team Lead experience in a US Healthcare account (Prior Authorization or Claims/Denial/Appeal) Excellent Leadership & Interpersonal relationship Strong Process Management & planning skills Embrace change and think operationally to achieve business goals Proven process improvement experience Seniority level Mid-Senior level Employment type Full-time Job function Management Industries Hospitals and Health Care and Telephone Call Centers #J-18808-Ljbffr