PHRN Team Leader

3 weeks ago

Cebu City, Central Visayas, Philippines Omega Healthcare Management Services Full time
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
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