Insurance Authorization and Benefits Specialist Operations Manager (Remote)

DO NOT APPLY IF YOU DO NOT MEET THE REQUIREMENTS: Authorization Verification and Benefits experience is required.

Experience in authorization and benefits for an ambulatory center setting is PREFEERED...

Job Summary:
The Insurance Authorization Verification and Benefits Specialist Operations Manager (Remote Worker) must have the ability to build a team and train the team with little to know training. The candidate will be able to hit the floor running day one. The remote operations manager will train, perform insurance authorization and benefits and be responsible daily to ensure the verification team completes all daily tasks. This role ensures that all processes related to insurance approvals, coverage analysis, and patient benefits verification are executed efficiently and in compliance with regulatory and payer-specific guidelines. The manager will lead a virtual team of specialists, optimize workflows, and maintain seamless communication with insurance providers, clinical staff, and patients, ensuring the smooth processing of authorizations and benefit determinations.

Key Responsibilities:
Remote Verification of Authorizations and Benefits

Be a part of our virtual team performing tasks relating to Insurance Verification of Authorizations and Benefit Specialist, ensuring high productivity and engagement in a remote work environment.
Conduct regular virtual team meetings and performance reviews, providing coaching and professional development opportunities to ensure team members meet performance expectations.
Monitor and assess staffing needs, hiring and onboarding new employees as necessary, ensuring they are trained effectively to work remotely.

Operational Oversight:
Assist programmer with Managing and oversee day-to-day remote operations of the insurance authorization and benefits verification process, ensuring the team meets deadlines and accuracy standards.
Ensure timely and accurate processing of pre-certifications, prior authorizations, and benefit verifications for various procedures, treatments, and services in the ambulatory surgery setting.
Establish and maintain remote workflows and procedures that enhance efficiency, reduce delays, and ensure compliance with payer-specific policies.
Handle escalations from the team, resolving complex issues related to insurance denials or discrepancies in coverage and benefits, even in a virtual environment.

Compliance and Reporting:
Ensure compliance with all relevant laws, regulations, and payer guidelines, leveraging remote tools to monitor processes.
Conduct regular audits of the authorization and benefits processes to ensure accuracy and compliance in remote operations.
Generate and analyze remote performance reports, providing insights into trends, workflow efficiency, and areas for process improvements.
Collaborate with compliance and billing departments to reduce claim denials and optimize reimbursement processes, even while managing a remote team.

Virtual Stakeholder Communication:
Serve as the primary point of contact for virtual communication between clinical staff, patients, and insurance providers to resolve benefit-related issues and answer coverage-related inquiries.
Build and maintain strong relationships with insurance carriers, facilitating quicker resolutions to authorization and benefits issues in a remote setting.
Provide regular updates to senior management on the team’s remote performance, operational metrics, and key trends affecting insurance authorizations and benefits processes.
Process Improvement:

Continuously seek opportunities to improve remote authorization processes, identifying gaps, inefficiencies, and potential cost-saving measures.
Research and implement remote tools, systems, and technologies that improve workflow efficiency and enhance communication with insurance payers.

Qualifications:
Education:
Bachelor’s degree in healthcare administration, business management, or a related field. Master’s degree preferred.

Experience:
3+ years of experience in insurance authorization and benefits verification, with at least 2 years in a leadership role, preferably managing remote teams.
Strong understanding of medical insurance, payer policies, and benefits verification processes in a virtual environment.
Experience with EMR systems and remote insurance authorization platforms.
Skills:

Excellent leadership and team management skills, with experience managing remote or distributed teams.
Strong problem-solving and critical thinking abilities, with attention to detail and the ability to navigate complex insurance issues remotely.
Proficiency with virtual communication tools (e.g., Zoom, Teams) and project management software.
Strong written and verbal communication skills, with the ability to effectively manage remote interactions with internal and external stakeholders.
Proficiency in Microsoft Office Suite and healthcare-related software systems.

Working Conditions:
Shift will be during US PST working hours 8am to 6pm Monday through Friday
This is a fully remote position, requiring consistent access to high-speed internet and suitable home office equipment.
Flexibility in working hours may be required to accommodate team and operational needs across different time zones.