Receipt And Distribution Supervisor

GENERAL DESCRIPTION: Responsible for monitoring operational activities related to the processing of pre-service organizational determination requests and clinical documentation, ensuring compliance with regulatory requirements and established operational standards by line of business. Monitors organizational determinations handled within the unit (Auto Approval) and those referred to clinical units, ensuring timeliness, and operational efficiency. ESSENTIAL FUNCTIONS: • Monitors and audits to ensure that the services related to the Organizational Determination process, such as Auto Approvals and those forwarded to the Clinical Affairs units comply with CMS and the applicable regulations for both business lines. • Monitors’ compliance with both business lines established regulatory and operational timeframes, ensuring the unit maintains compliance in global reports. • Analyze root cause and/or trends of untimely cases in the corresponding turnaround time reports (TAT), for developing operational strategies. • Monitors operational daily backload for surveillance of requests aging in conjunction with team leaders to outline strategies and to identify potential cases of non-compliance and manage operational plans with the team. • Oversee that the workflows are conducted appropriately including requests for initial evaluation, validation of eligibility, pre-authorization requirements, and complete accurate documentation in the system, and that the distribution to the corresponding areas occurs in the established time. • Conducts random sample audits for early identification of findings. • Maintains and monitors metrics to ensure that organizational determination requests are assembled within the established time and according to the programs. Monitoring operational efficiency with production reports and auditing the quality of data entry through different reports. • Monitors that the technicians and team leader in charge comply with their daily production. • Oversee the work plan of the supervised team leader to outline operational plans and daily priorities. • Develop corrective action plans according to the main cause of non-compliance situations. Maintains the organization of their employees' documentation for easy root cause analysis and determining the need for reinforcements and/or retraining. • Perform retraining and/or process reinforcement and/or reengineering interventions as required. ADDITIONAL FUNCTIONS: • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience in this document. • Supervises, monitors, trains, evaluates and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave according to the policies, standards, norms, and procedures of the Company. MINIMUM QUALIFICATIONS: Education and Experience: Bachelor's degree preferably in Health Services Administration or health-related areas. At least three (3) years of experience in a similar health service position. At least one (1) year of experience supervising staff. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: N/A Other: Knowledge of ICD-10 and CPT codes. Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)