Supervisor, Insurance Analyst

Role Summary

A role that provides leadership, support, and supervision for the Insurance Analyst team. The incumbent is a subject matter expert on commercial pharmacy, major medical, and government insurance plans, prior authorizations, appeals, and alternate coverage referrals. The supervisor ensures daily team activities run smoothly to deliver the best customer experience for physician offices and patients. The role is responsible for meeting performance metrics, workload deliverables, and customer service activities in alignment with a high-touch business model.

Responsibilities

• Supervise and oversee insurance analysts responsible for verifying new patient insurance benefits and handling claim rejections. Work proactively with staff and cross-functional groups to develop creative solutions to challenging patient access issues regarding prior authorization, and denied coverage requests to ensure patient care.
• Partner with Leads to monitor work flow and adjust workload and staffing requirements to ensure that all activities are addressed in a timely and efficient manner.
• Monitor calls and perform case reviews to ensure accuracy of information, adherence to policies, and excellent customer service. Provide additional coaching and training to individuals as needed. Meet regularly with direct reports to provide direct feedback on their performance and progress against goals. Responsible for writing and communicating performance reviews.
• Perform administrative tasks such as work hour scheduling, attendance monitoring and counseling, vacation request scheduling, and overtime scheduling. Participate in the hiring process and handle all employee issues for their direct reports.
• Use effective coaching and management techniques to maintain a highly motivated and interactive work staff.
• Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics. Provide activity metrics, status updates, and local payor intelligence information to management per established guidelines. Elevate issues as appropriate.
• Consistently build and maintain collaborative relationships cross-functionally to ensure a seamless customer experience for patients and physicians.
• Identify process improvements to increase operational efficiencies and develop action plan for execution. Assist with the implementation of new projects and products within the Pharmacy.
• Understand and comply with all required training, including adherence to applicable federal, state, and local pharmacy laws, HIPAA and privacy policies and guidelines, and the policies and procedures of the business.
• Perform additional tasks, activities, and projects as deemed necessary by management.

Qualifications

• Bachelor’s degree or Associate Degree in health sciences or business preferred. Comparable or relevant experience will be considered.
• 3-5 years of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization, appeals, and specialty pharmacy operations
• 1-2 years supervisory experience in a call center, large physician, managed care, or healthcare insurance setting desired
• Demonstrated strong, accurate technical skills. Must be detail oriented. Must have a thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.
• Proven leadership and coaching skills. Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy.
• Must have professional written and verbal communication skills to interact with and build and maintain relationships with all levels of the organization. Must maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
• Proven organizational, time management, and problem solving skills, elevating to management when appropriate.
• Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.