Trinity Health
Authorization and Denial Supervisor - Hybrid
Must be local to Albany, NY Employment Type: Full time | Shift: Day Shift | Location: Hybrid (Albany, NY) Summary
This position is responsible for oversight of authorization and denials within the assigned service line, ensuring appropriate prior authorization for related services, drugs, treatments, and supplies. The supervisor assists in the identification, reporting, and resolution of issues stemming from or with authorization and denial processes. Using data, system reports, and analytics, the supervisor supports the needs of the authorization team and is instrumental in developing and implementing strategies to optimize all aspects of authorization and denials, supporting the revenue integrity team through a comprehensive approach. The scope of prior authorizations may include (but is not limited to) consults, diagnostic testing in office procedures, and pharmaceuticals including off‑label drugs and drugs for clinical trials. Job Duties and Responsibilities
Leads efforts to ensure staff are properly trained, onboarded, and regularly evaluated on competencies and quality of work. Leads oversight of appeals and denied claims for related services, drugs, treatments and supplies. Obtains and ensures timely prior authorizations for related services, drugs, treatments, and supplies according to the care plan as outlined by providers. Assists interdepartmental teams in troubleshooting accounts held in A/R due to lack of prior authorizations. Facilitates communication with care team and providers. Appeals denied authorizations for related services, drugs, treatments, and supplies. Researches denials and provides additional supporting documentation to appeal decisions. Communicates appeal decisions with the care team and obtains additional required documentation to ensure claims are paid. Identifies opportunities and participates in optimization of the EHR to track and submit authorizations to payors. Partners with leadership to educate providers and clinical staff on payor policy changes related to the administration of treatments. Prepares accurate reports and provides departmental summary information to the Revenue Cycle Team and leadership to ensure all infusions and laboratory testing performed in the department are reviewed and prior authorization or predetermination is obtained. Contributes to the effective management of the department. Demonstrates dependability by adhering to departmental performance standards and attendance guidelines. Supports time management by being punctual to scheduled meetings and to work, starting work promptly, and adhering to scheduled hours and performance standards. Works collaboratively and supports team members. Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff, and the broader health care community. Qualifications
Associate degree and one to two (1–2) years of similar healthcare experience required; or, in lieu of an associate's degree, a high school diploma/GED and five (5) or more years of similar healthcare experience will be considered. Preferred certification in CCS, CCS-P, CPC, or specialty coding. Three to five years of experience in a healthcare environment with exposure to a patient population and the types of services patients receive. Prior authorization experience involving drugs and ancillary testing desirable. Knowledge of managed care and third‑party payer benefit designs and reimbursement requirements. Knowledge of ICD‑9 and ICD‑10 coding and documentation requirements. Proficiency in Microsoft Office applications including Outlook, Word, and Excel. Preferred experience in Epic or a comparable EMR system. Strong analytical skills with attention to detail and a high degree of accuracy to produce reports, analyses, and other details as requested. Strong communication skills and attention to detail; knowledge of drug regimens and associated regulations/policies/procedures applicable to insurance coverage and the associated payment for and appeal of procedures/billing rejected. Two years of experience in reviewing medical records for National Coverage Determinations (NCD) and local Coverage Determinations (LCD). Strong understanding of HIPAA laws and requirements as they relate to review and reporting of documentation. Pay Range
$25.85 – $37.50 per hour, based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location. Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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Must be local to Albany, NY Employment Type: Full time | Shift: Day Shift | Location: Hybrid (Albany, NY) Summary
This position is responsible for oversight of authorization and denials within the assigned service line, ensuring appropriate prior authorization for related services, drugs, treatments, and supplies. The supervisor assists in the identification, reporting, and resolution of issues stemming from or with authorization and denial processes. Using data, system reports, and analytics, the supervisor supports the needs of the authorization team and is instrumental in developing and implementing strategies to optimize all aspects of authorization and denials, supporting the revenue integrity team through a comprehensive approach. The scope of prior authorizations may include (but is not limited to) consults, diagnostic testing in office procedures, and pharmaceuticals including off‑label drugs and drugs for clinical trials. Job Duties and Responsibilities
Leads efforts to ensure staff are properly trained, onboarded, and regularly evaluated on competencies and quality of work. Leads oversight of appeals and denied claims for related services, drugs, treatments and supplies. Obtains and ensures timely prior authorizations for related services, drugs, treatments, and supplies according to the care plan as outlined by providers. Assists interdepartmental teams in troubleshooting accounts held in A/R due to lack of prior authorizations. Facilitates communication with care team and providers. Appeals denied authorizations for related services, drugs, treatments, and supplies. Researches denials and provides additional supporting documentation to appeal decisions. Communicates appeal decisions with the care team and obtains additional required documentation to ensure claims are paid. Identifies opportunities and participates in optimization of the EHR to track and submit authorizations to payors. Partners with leadership to educate providers and clinical staff on payor policy changes related to the administration of treatments. Prepares accurate reports and provides departmental summary information to the Revenue Cycle Team and leadership to ensure all infusions and laboratory testing performed in the department are reviewed and prior authorization or predetermination is obtained. Contributes to the effective management of the department. Demonstrates dependability by adhering to departmental performance standards and attendance guidelines. Supports time management by being punctual to scheduled meetings and to work, starting work promptly, and adhering to scheduled hours and performance standards. Works collaboratively and supports team members. Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff, and the broader health care community. Qualifications
Associate degree and one to two (1–2) years of similar healthcare experience required; or, in lieu of an associate's degree, a high school diploma/GED and five (5) or more years of similar healthcare experience will be considered. Preferred certification in CCS, CCS-P, CPC, or specialty coding. Three to five years of experience in a healthcare environment with exposure to a patient population and the types of services patients receive. Prior authorization experience involving drugs and ancillary testing desirable. Knowledge of managed care and third‑party payer benefit designs and reimbursement requirements. Knowledge of ICD‑9 and ICD‑10 coding and documentation requirements. Proficiency in Microsoft Office applications including Outlook, Word, and Excel. Preferred experience in Epic or a comparable EMR system. Strong analytical skills with attention to detail and a high degree of accuracy to produce reports, analyses, and other details as requested. Strong communication skills and attention to detail; knowledge of drug regimens and associated regulations/policies/procedures applicable to insurance coverage and the associated payment for and appeal of procedures/billing rejected. Two years of experience in reviewing medical records for National Coverage Determinations (NCD) and local Coverage Determinations (LCD). Strong understanding of HIPAA laws and requirements as they relate to review and reporting of documentation. Pay Range
$25.85 – $37.50 per hour, based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location. Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person‑centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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