L5 – Supervisor (DS_E&B_WWS & Prior Authorization

Role Overview:
As an L5 Supervisor – Medical Billing, you will oversee the daily operations of the medical billing team, focusing specifically on the Eligibility & Benefits (DS_E&B_WWS) and Prior Authorization (Prior Authorization_WWS) processes within the revenue cycle. You will ensure accurate and timely handling of patient eligibility verification, benefits determination, prior authorization requests, and billing practices. You will manage a team of billing professionals, ensuring compliance with healthcare regulations and optimizing operational efficiency across the revenue cycle.

Key Responsibilities:

Team Supervision & Leadership:
Lead and manage a team responsible for eligibility verification, benefits determination, and prior authorization processes. Provide day-to-day guidance and support, ensuring team members meet departmental and organizational goals.
Eligibility & Benefits Verification (DS_E&B_WWS):
Supervise the accurate and timely verification of patient eligibility and benefits with insurance companies. Ensure the correct processing of eligibility inquiries and that coverage information is appropriately recorded in the system.
Prior Authorization Management:
Oversee the process of obtaining prior authorization for necessary medical procedures and services. Ensure compliance with payer requirements and ensure prior authorization requests are submitted and tracked accurately.
Billing & Coding Coordination:
Coordinate the accurate and timely submission of claims and ensure appropriate coding and billing practices in accordance with payer policies and healthcare regulations.
Compliance & Regulatory Adherence:
Ensure that the team adheres to all healthcare regulations, payer requirements, and organizational policies for eligibility, benefits, and prior authorization. Stay updated on changes in regulations and ensure the team follows any required process adjustments.
Process Improvement:
Evaluate and improve processes related to eligibility verification, prior authorization, and billing to enhance efficiency and reduce the risk of claim denials or delays.
Reporting & Performance Metrics:
Monitor and analyze key performance metrics such as authorization turnaround times, eligibility verification accuracy, claim submission rates, and denial rates. Prepare and present regular reports to senior management with insights and recommendations for improvement.
Problem Resolution:
Act as a point of escalation for complex eligibility, benefits, or prior authorization issues. Collaborate with insurance companies and healthcare providers to resolve any disputes or discrepancies.
Training & Development:
Provide ongoing training and support to the billing team, ensuring they are well-versed in eligibility verification procedures, prior authorization requirements, and system usage. Foster a culture of continuous learning within the team.
Cross-Functional Collaboration:
Work closely with other departments, such as coding, billing, and insurance verification, to ensure a seamless revenue cycle. Address any cross-departmental challenges and ensure smooth communication for timely claim processing.

Desired Candidate Profile:

Bachelor’s degree in Healthcare Administration, Medical Billing, Health Information Management, or a related field.
Certification in Medical Billing (e.g., CBCS, CCB, or equivalent) is highly preferred.
Minimum of 5 years of experience in medical billing, with at least 2 years in a supervisory or leadership role in revenue cycle operations.
Strong knowledge of eligibility and benefits verification, prior authorization processes, and healthcare billing systems.
In-depth understanding of payer requirements, healthcare regulations, and revenue cycle processes.
Proven ability to lead a team, develop staff, and achieve departmental goals.
Excellent problem-solving and decision-making skills.
Proficiency in medical billing software, Electronic Health Record (EHR) systems, and other related tools.

What We Offer: