Supervisor of Precertification

Location:

Southwoods Executive Centre – Boardman, Ohio

The Supervisor of Precertification provides direct oversight, coordination, and continuous improvement of all precertification and prior authorization functions. This role ensures compliance with medical necessity, payer authorization rules, and related financial processes to support timely and accurate billing.

The Supervisor provides leadership, training, and performance management for staff involved in these critical processes. This position drives excellence by monitoring workflows, analyzing key performance indicators (KPIs), and implementing process improvements aimed at reducing denials, improving cash flow, and ensuring compliance with payer requirements and regulatory guidelines.

• Team Leadership:
  Directly supervises staff responsible for precertification and prior authorizations; manages recruitment, training, payroll, and performance appraisals.
• Operational Oversight:
  Monitors staffing schedules to ensure adequate coverage and serves as the liaison for authorization and utilization management needs for the Case Management department.
• Authorization Management:
  Reviews surgical schedules daily to identify cases requiring prior authorization; coordinates with scheduling teams, providers, and payers to secure approvals before the date of service.
• Quality Assurance:
  Monitors and maintains quality for all authorizations to prevent denials and ensure timely claim payment.
• Specialized Claims:
  Ensures all Workers' Compensation cases follow established organizational procedures and payer-specific requirements.
• Compliance & Industry Standards:
  Stays current on governmental regulations, payer changes, and industry best practices, communicating updates to staff.
• Revenue Cycle
  
  Collaboration:
  
  Partners with revenue cycle leadership to perform root-cause analysis on denials and implements corrective actions.
• Process Improvement:
  Recommends and implements process revisions to improve efficiency, compliance, and financial performance.
• Facility Compliance:
  Ensures all processes maintain compliance with regulatory agencies.

• Education:
  
  Associate or Bachelor's degree in Business Administration or a related field; OR five or more years of progressive experience in medical billing, insurance claims, or revenue cycle operations.
• Required Skills:
  
  Training or coursework in business office activities, computer skills, and medical terminology.
• Certification/Licensure:
  • Certified Revenue Cycle Representative (CRCR) preferred.
  • RN with an active license in the State of Ohio preferred.

• Minimum of 5 years’ experience in Patient Access or healthcare Revenue Cycle.
• 1–3 years of supervisory experience preferred.
• Strong critical thinking and problem-solving skills.
• Excellent communication skills and meticulous attention to detail.
• Results-driven leadership with superior time-management skills.
• Ability to maintain a professional demeanor at all times.

Full-time, Monday–Friday. Day shift; no evenings or weekends.

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