Manager, Enterprise Authorization Services

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and manage activities related to insurance prior authorization.

• Investigate and evaluate denied services to design and implement workflows aimed at reducing payment denials.

• Lead, train, develop, direct, and assess a team of authorization specialists.

• Communicate potential revenue risks to Departmental Directors and Clinic Administrators.

• Review productivity and timeliness of authorizations; create and execute action plans.

• Monitor team staffing levels and redistribute work based on organizational priorities.

• Evaluate the work of authorization staff for quality, productivity, and timely submission of authorizations and treatment plans.

• Track trends in insurance authorization and reimbursement data and share findings with the Director.

• Identify, implement, monitor, and adjust process improvement initiatives.

• Suggest technological enhancements to boost performance and productivity.

• Stay informed about payer authorization requirements and state/federal coverage regulations.

• Manage pre-certification workflows for designated services.

• Examine denial management metrics and spearhead initiatives to reduce denials.

• Collaborate with hospital billing, professional billing, Outpatient Registration, and Revenue Cycle teams to address complex denial and authorization challenges.

• Oversee assigned hospital functions, ensure timely reviews, and support front-end peer-to-peer appeals.

• Represent pre-authorization services in pertinent internal and external meetings.

• Assess new services for guidance on pre-authorization and denial reduction.

⛳️ Requirements

• High School Diploma or Equivalent.

• Five (5) years of experience in healthcare accounts receivables management, billing, and collections.

• Two (2) years of supervisory experience.

• Proficiency in computers and the ability to use, manipulate, and apply data for administrative purposes.

• Familiarity with Medicare, Medicaid, and other regulatory standards.

• Understanding of UB-04, itemized bills, insurance plans, grievance procedures, and utilization management processes.

• Knowledge of managed care, both inpatient and outpatient care, utilization management, and InterQual criteria.

• Familiarity with patient billing operations.

• Understanding of medical terminology and capability to interpret medical record information.

• Knowledge of CPT, ICD9/10, and DRGs.

• Previous experience in an administrative or supervisory position.

• Strong organizational skills, attention to detail, initiative, and follow-through.

• Preferred: Bachelor’s degree in Finance, Business Administration, or a related field.

• Preferred: Certified Healthcare Financial Professional (CHFP) with HFMA.

• Preferred: Familiarity with the EPIC system.

🏝️ Benefits

• Full-time schedule of 40 hours per week.

• Exempt status.