Prior Authorization Supervisor

LOCATION: 600 HOLIDAY PLAZA DR, MATTESON, IL 60443

DEPARTMENT: Revenue

SHIFT: 8:00AM - 4:00PM

PAY RANGE: $109,309-$123,683 YEARLY

Salary is commensurate with years of experience indicated at time of application submittal. Experience not disclosed or documented at the time of application will not be considered for initial step placement.

The Prior Authorization Manager supervises, consults, and guides prior authorization staff responsible for responding to all prior authorization requests. The Prior Authorization Manager ensures all requests are complete to include inpatient, outpatient, procedures, and therapies in accordance with best practices, Cook County Health (CCH) Policies and Procedures and Health Plan standards. The Prior Authorization Manager ensures all documentation is obtained to support level of care, medical appropriateness, and authorization.

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policies and procedures
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

• Oversees the day-to-day operations and supervision of the Prior Authorization team including drug, imaging, surgery, radiation oncology, etc., providing expertise and guidance across Cook County Health.
• Routinely reviews and communicates payer authorization guidelines, and policy changes to the Prior Authorization staff.
• Communicates with physician/clinical staff on escalated reimbursement issues and/or off label drug usage utilizing guidelines set forth by the patient’s insurance.
• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow‑up is performed.
• Oversees the orientation and training of new employees and provide on‑site training as needed.
• Provides backup coverage as needed to the Prior Authorization team.
• Performs monthly audits for each employee to ensure data quality, insurance verification, and overall account documentation compliance.
• Recommends action to outside stakeholders, as necessary, to resolve problems proactively.
• Remains current with industry trends, changes to insurance policies, and other developments that may impact the authorization process.
• Engages in process and quality improvement initiatives.
• Complies with patient confidentiality policies for the retention of patient information, handling, distributing, or disposing of patient health information.
• Reports to the Prior Authorization Manager.
• Performs other duties as assigned

• High School diploma or GED equivalent with six (6) years of prior authorization experience or Bachelors with three (3) of prior authorization experience (Must provide copy of official college transcripts at time of interview). Is Required
• A minimum of Four ((4) years of experience processing insurance request to obtain prior authorization. Is Required
• Experience and familiarity with using insurance portals, i.e., Anthem, Availty, Evicor, Covermymeds, Magellang. Is Required