Manager, Prior Authorizations

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

📋 Description

• Oversee all functions of the prior authorization department, ensuring timely and precise submissions, renewals/extensions, follow-ups, and appeals, including requests for single case agreements or gap exceptions.

• Evaluate clinical review and prior authorization results from various sources, including carrier denial exception reporting, first pass approval rates, appeal effectiveness, and clinical relevance rates.

• Collaborate across departments to manage the full process from receiving patient clinical records, submitting prior authorizations, to final determinations.

• Communicate with internal departments to foster ongoing dialogue and collaboration on cross-functional projects aimed at optimizing prior authorization processes.

• Ensure that all performance metrics are met and create actionable strategies to swiftly and effectively address any shortcomings that arise.

• Offer departmental orientation and continuous training for all direct and indirect reports.

• Proactively seek optimization opportunities to enhance automation, improve workflows, and achieve efficiency gains.

• Collaborate with both internal and external stakeholders to drive approval outcomes, thereby reducing revenue leakage.

• Recruit and supervise all staff members, fostering a culture of respect, engagement, accountability, and results.

• Comply with the Pledge of Confidentiality.

⛳️ Requirements

• Bachelor’s degree.

• 3-5 years of leadership experience in healthcare revenue cycle management, with a focus on prior authorization management.

• Strong knowledge of clinical review and prior authorization processes.

• Demonstrated success in achieving challenging metrics and outcomes.

🏝️ Benefits

• Medical.

• Dental.

• 401K with Match.

• Pay equity initiatives.