Referral and Authorization Supervisor

JOB SUMMARY:

The Referral & Authorization Supervisor is responsible for overseeing the centralized referral and prior authorization teams while actively performing key duties within both areas. This role ensures the seamless operation of referral coordination and prior authorization processes, maintaining compliance with organizational and payer requirements. The supervisor acts as a resource for team members, promotes exceptional patient care, and supports the overall goals of Northern Maine Medical Center.

ESSENTIAL FUNCTIONS:

• Manage day-to-day operations of the referral and prior authorization teams, ensuring efficient workflows and high-quality service.
• Serve as a liaison between patients, providers, and payers to facilitate smooth communication and coordination of care.
• Train, mentor, and evaluate team members, fostering professional growth and ensuring adherence to organizational policies and procedures.
• Monitor and assign work queues, ensuring timely processing of referrals and authorizations.
• Assist in processing referrals and prior authorizations, including:
• • Reviewing medical records to extract pertinent clinical information.
  • Obtaining prior authorizations in accordance with payer requirements.
  • Communicating with patients to provide updates and gather necessary information.
• Maintain accurate records and documentation within the electronic medical record (EMR) system, ensuring compliance with HIPAA regulations.
• Identify and address barriers to efficient operations, recommending and implementing process improvements.
• Stay up to date with changes in payer policies, EMR updates, and industry best practices.
• Collaborate with other departments to ensure accurate and timely sharing of information.
• Protect patient privacy and confidentiality, maintaining a professional and courteous demeanor at all times.
• Perform additional duties as assigned, supporting the goals of Northern Maine Medical Center.