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Supervisor, Prior Authorization (Kentucky)

Company: MedImpact
Location: Tempe
Posted on: November 18, 2021

Job Description:

Supervisor, Prior Authorization MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! The Scoop: Supervises day-to-day operations in the achievement of defined service objectives. Supports management to assure team alignment with the overall goals and objectives of the Prior Authorization department and the Corporation. Provides leadership to ensure the highest levels of quality, service, performance levels, and efficiency standards are implemented and maintained. Trains and develops frontline staff to successfully perform their duties and advance within the PA processing career path. Relies on knowledge and experience of healthcare operations concepts, practices and procedures. A wide degree of independence, latitude and creativity is expected. What You Get To Do:

  • Primary responsibility is oversight of the Clinical call center for KY to maintain clinical call center services to respond to inquiries, adjudicate PA requests, initiate PA appeals, triage escalated calls to KY licensed pharmacists and reconsiderations from pharmacy and providers between the hours of 8 AM - 7 PM EST Mon-Friday
  • Ensure adequate coverage of call center by staff to meet performance metrics as required by KY contract (includes average speed of answer, abandonment rate, blocked calls)
  • During call idle time, reporting PAC staff will continue to process prior authorization cases
  • Supervisor functionality will also include oversight of efficiency and quality of PA processing, including application of P&T Approved PA guidelines, proper effectuation of approvals, or deferrals to pharmacists and finalization of cases (including proper selection of denial templates, free text and reason codes) for provider and member notification
  • Responsible for delivering exceptional service to customers, including open channels of communication, prompt response to inquiries and requests, and timely, accurate results that meet client specifications
  • Ensures that staff is properly trained and supervised in order to timely and accurately execute processing needs in compliance with performance standards and regulatory agencies
  • Performs frontline supervision including interviewing and recommending candidates for hire, training and developing team members, assigning and monitoring work in progress, evaluating performance, enforcing attendance & performance standards, administering employee corrective action, and making compensation recommendations
  • Models and cultivates staff behaviors that achieve business success, including leadership skills, collaboration, accountability, and ownership
  • Ensures that staff members are aware of business plan objectives, individual accountabilities, and the competencies critical to successful job performance
  • Supervises assigned work group to achieve service commitments, including sustainable, measurable, accurate, reliable, and timely execution of service deliverables
  • Provides day-to-day leadership by developing and administering policies, business processes, quality standards, and performance measurement criteria
  • Sets high standards and encourages new ideas for improving organizational performance
  • Partners with other MedImpact teams to effectively resolve customer issues and inquiries, implement new business, design solutions that meet the mutual needs of MedImpact and our customers
  • Participates as a member of cross functional workgroups, teams, and committees as assigned
  • Sets high standards and encourages new ideas for improving team performance
  • Promotes continuous improvement by documenting processes, assigning roles & responsibilities, and measuring results
  • Seeks out and actively participates in business initiatives that contribute to service excellence
  • Utilizes planning, prioritizing, and organizational skills to effectively deploy the assets, tools, and processes necessary to achieve business objectives
  • Maintains commitment to operational goals in the face of obstacles and collaborates with internal customers
  • Cultivates positive relationships with MedImpact customers through direct interaction and by achieving positive customer satisfaction results
  • Promptly responds to service failures, resolves issues, and escalates concerns as appropriate Education and/or Experience
    • For consideration candidates will need a Bachelor's degree from four-year College or university; or equivalent combination of education and experience
    • Two (2) to five (5) years related experience and/or training
    • Two (2) years supervisory experience in healthcare or claims processing preferred
    • Prior PBM, healthcare, or managed care experience preferred Computer Skills Proficiency with MS Windows Office programs, including MS Word, Excel, and Outlook to create complex documents, manage schedules, and analyze data. Certificates, Licenses, Registrations
      • Must successfully complete one of the national certification exams OR obtain state licensure (in an U.S. State or Territory)
      • Maintains a current Pharmacy Technician License and/or CPhT certification without restriction Other Skills and Abilities
        • Excellent skills in written and oral communication; organization/prioritization; decision-making; problem analysis and resolution; negotiation; team building; and leadership
        • Ability to maintain a high degree of confidentiality using, tact, discretion, and professionalism in all aspects of the job
        • Strong attention to detail and follow-through skills
        • Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
        • Demonstrated ability to meet or exceed the competencies as listed Travel
          • This position requires travel a minimum of 10% of the time
          • Also, attendance maybe required at various local training sessions and/or meetings The Perks:
            • Medical / Dental / Vision / Wellness Programs
            • Paid Time Off / Company Paid Holidays
            • 401K with Company match
            • Life and Disability Insurance
            • Tuition Reimbursement
            • Employee Referral Bonus This position is eligible for Employee Referral Bonus at Level I To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets. EOE, M/F/D/V OSHA/ADA: To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Keywords: MedImpact, Tempe , Supervisor, Prior Authorization (Kentucky), Other , Tempe, Arizona

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