Director of Procedure & Training for Prior Auth & Denial Compliance

Job description

Position Summary: The Director, Prior Authorization will be responsible for development of and maintenance of Prior Authorization and Denial Compliance Job Aids, Work Flows, procedures & related documents and ensuring alignment with HPN and regulatory Policies and guidance in compliance with DMHC, DHCS, CMS & NCQA requirements, as well as Health Plan contractual obligations. This role will develops & maintain Prior Authorization training related to Prior Authorization and identify best practices and process improvements based on internal, health plan, regulatory, and HPN audits/reviews. The role will develops tools to assist the Prior Authorization management and staff in implementing new or updated Policies & Procedures, in addition reviews results provided by HPN and internal oversight audits and monitoring mechanisms and develops tools and aids to assist Prior Authorization in improving compliance and service results. In collaboration with colleagues, the Director is also responsible for the development of job aids & work flows as well as training materials (Presentation, delivery, tips, etc.) to assist in improving the performance and consistency of the Prior Authorization func...