Prior Authorization Supervisor (Non-Clinical)

Summary/Position Objectives:
Reporting to the Prior Authorization Manager, incumbent will supervise the department work activities in order to ensure that service standards are met and that operations are consistent with the health plan policies, as well as the policies of regulatory agencies. Incumbent assures that all authorization requests are responded to in a professional, competent manner while applying appropriate medical criteria and policies. Incumbent is responsible for overseeing the day-to-day operational activities of the Prior Authorization Department. Assisting with the development and evaluation of programs designed to promote the efficient delivery of Prior Authorization services.


Responsibilities:
Essential Functions:
Supervises, advises and facilitates the ongoing development and education of the prior authorization staff.
Supervises the day to day activities of the prior authorization department, to insure staff work within timelines based on the Health Plan’s policies.
Ensures service standards of the Health Plan are met.
Identifies problem areas and participates in the development and implementation of appropriate corrective action.
Participates in the evaluation of the effectiveness and efficiency of the prior authorization process.
Interfaces with all departments within the health plan to ensure appropriate support for all prior authorization activities.
Oversees the duties of the PA Nurse, assuring that all requests for medical appropriateness use the established criteria hierarchy to determine the medical necessity of the request.
Demonstrates support of the Health Plan’s needs to be cost effective in terms of resources, material and time.
Develop, establish, and maintain a work priority system to ensure daily and heavy workloads are fulfilled.

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Incumbent must have strong team leadership, problem solving, organizational, and time management skills with the ability to work in a fast paced environment. Excellent oral and written communication skills are necessary. The ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate resolution is required. Proficient use of Microsoft Office Suite and common computer and office hardware is necessary. Must be able to work independently and with minimal supervision.

Education and Work Experience:
Bachelors degree preferred or equivalent education /experience. Minimum of three years in healthcare industry. Management or supervisory experience preferred.