福利资格与授权主管
Supervisor - Benefits Eligibility and Authorization
主管，福利资格与授权
关于Navista
我们相信社区肿瘤学的力量可以支持患者完成他们的癌症旅程。作为由40多个站点组成的肿瘤学实践联盟，Navista为社区实践提供支持，以推动其增长——同时保持其独立性。
Revenue Cycle Management（RCM）对Cardinal Health的贡献
实践运营管理负责医疗实践的业务和行政运营。
Revenue Cycle Management管理一个专注于一系列临床和行政流程的团队，医疗保健提供者利用这些流程来捕获、计费和收取患者服务收入。收入周期贯穿整个患者护理旅程，从患者预约安排开始，到患者的账户余额为零结束。
职责
- 监督和协调肿瘤授权团队的日常活动，确保授权请求和财务清关活动及时完成。
- 监控工作队列，分配优先级，管理员工生产力，以支持及时的患者治疗和服务安排。
- 监督医学肿瘤学、放射肿瘤学、影像学、基因检测、手术、专科药物和辅助服务的前期授权、转诊和医疗必要性流程。
- 审查升级的案例、被拒的授权、紧急治疗请求和保险公司问题，确保及时解决。
- 确保在服务前获得授权，适当跟踪，并根据需要更新或延长，以避免治疗延误。
- 与医生、高级执业人员、护士、药房、排班和财务咨询团队合作，解决授权障碍，支持患者治疗准备。
- 进行每日例会、员工辅导和流程审查，以推动责任、质量和优质服务。
- 监控授权处理时间、积压库存、待处理请求和高优先级患者案例，确保部门绩效目标的达成。
- 保持对保险公司政策、医疗必要性要求、授权指南和影响肿瘤学服务的法规变化的专业知识。
- 审查与授权相关的拒付，识别根本原因，并实施纠正措施，以减少收入流失并防止重复问题。
- 执行质量审计，以确保授权准确性
查看英文原文
Supervisor, Benefits Eligibility and Authorization
About Navista
We believe in the power of community oncology to support patients through their cancer journeys. As an oncology practice alliance comprised of more than 40 sites, Navista provides the support community practices need to fuel their growth—while maintaining their independence.
What Revenue Cycle Management (RCM) contributes to Cardinal Health
Practice Operations Management oversees the business and administrative operations of medical practices.
The Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero.
Responsibilities
- Supervise and coordinate the daily activities of the oncology authorization team to ensure timely completion of authorization requests and financial clearance activities.
- Monitor work queues, assign priorities, and manage staff productivity to support timely patient treatment and service scheduling.
- Oversee prior authorization, referral, and medical necessity processes for medical oncology, radiation oncology, imaging, genetic testing, surgery, specialty medications, and ancillary services.
- Review escalated cases, denied authorizations, urgent treatment requests, and payer issues to ensure timely resolution.
- Ensure authorizations are obtained prior to service, tracked appropriately, and renewed or extended as needed to avoid treatment delays.
- Collaborate with physicians, advanced practice providers, nursing, pharmacy, scheduling, and financial counseling teams to resolve authorization barriers and support patient readiness for treatment.
- Conduct daily huddles, staff coaching, and workflow reviews to drive accountability, quality, and service excellence.
- Monitor authorization turnaround times, aging inventories, pending requests, and high-priority patient cases to ensure departmental performance goals are met.
- Maintain expertise on payer policies, medical necessity requirements, authorization guidelines, and regulatory changes impacting oncology services.
- Review authorization-related denials, identify root causes, and implement corrective actions to reduce revenue leakage and prevent recurring issues.
- Perform quality audits to ensure authorization accuracy, documentation compliance, and adherence to organizational policies and procedures.
- Develop and maintain department standard operating procedures, training materials, and payer-specific workflows.
- Generate and analyze daily, weekly, and monthly operational reports, including authorization approval rates, denial trends, productivity, and turnaround times.
- Partner with Revenue Cycle, Patient Access, Managed Care, and Clinical Leadership teams to improve authorization efficiency and financial performance.
- Support staff development through training, performance management, mentoring, and competency assessments.
- Ensure compliance with Medicare, Medicaid, commercial payer, IPA, and other regulatory requirements governing authorization and financial clearance activities.
- Serve as the primary escalation point for complex authorization issues, payer disputes, peer-to-peer reviews, and treatment-related access concerns.
- Lead continuous improvement initiatives focused on reducing treatment delays, improving patient experience, increasing authorization approval rates, and minimizing preventable denials
Qualifications
- Bachelor's degree in Healthcare Administration, Business, Nursing, or related field preferred.
- Minimum five (5) years of healthcare prior authorization, financial clearance, patient access, or revenue cycle experience preferred
- Minimum two (2) years of leadership, supervisory, or team lead experience in a healthcare setting preferred
- Oncology, infusion, radiation oncology, specialty pharmacy, or multi-specialty authorization experience strongly preferred.
- Extensive knowledge of medical oncology treatment regimens, radiation oncology services, imaging, genetic testing, surgical procedures, and specialty referrals.
- Strong understanding of Medicare, Medicaid, commercial payer, HMO, IPA, and delegated authorization requirements.
- Experience managing prior authorization workflows, referral management, medical necessity review, and payer compliance.
- Proven ability to reduce authorization-related denials, treatment delays, and revenue risk through effective operational oversight.
What is expected of you and others at this level
- Experience developing, monitoring, and reporting operational KPIs, productivity metrics, quality audits, and performance dashboards.
- Strong analytical, problem-solving, and process improvement skills with the ability to identify trends and implement corrective actions.
- Excellent leadership, coaching, performance management, and employee development skills.
- Ability to effectively manage workload prioritization in a fast-paced oncology environment with competing patient care and payer deadlines.
- Strong communication and relationship-building skills with physicians, clinical staff, executives, payers, and external partners.
- Proficiency with electronic health records (EHRs), practice management systems, authorization platforms, Microsoft Excel, and reporting tools.
- Demonstrated commitment to compliance, regulatory requirements, patient-centered care, and operational excellence.
- Preferred certifications include CRCR, CHAM, CPAR, CPC, or other revenue cycle, reimbursement, or healthcare access certifications.
Anticipated salary range: $76,700.00 - $98,460.00
Bonus eligible: No
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
- Medical, dental and vision coverage
- Paid time off plan
- Health savings account (HSA)
- 401k savings plan
- Access to wages before pay day with myFlexPay
- Flexible spending accounts (FSAs)
- Short- and long-term disability coverage
- Work-Life resources
- Paid parental leave
- Healthy lifestyle programs
Application window anticipated to close: 11/16/2026 if interested in opportunity, please submit application as soon as possible.
The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
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Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.
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Originally posted on Himalayas