Manager, Prior Authorizations

POSITION SUMMARY:

The Prior Authorization Manager will effectively lead the Prior Authorization functional area within billing, collection or accounts receivable management, maintaining a full understanding of the billing information system. Manages the activities of staff through daily supervision while overseeing designated functional areas across the revenue cycle department including, but not limited to, billing and pre-certification. Assists with implementing strategic goals by deploying internal and external staff.

PRIMARY RESPONSIBILITIES: 

• Experience with managing large teams, including supervision of staff of a pre-certification department.
• Experience with directing self and others in areas of responsibility such as research, appeals, order entry, pre-certification and eligibility.
• Assists with feedback for hiring, discipline and performance evaluations.
• Provides department orientation and ongoing training for all in/direct reports.
• Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization.
• Analyzes prior authorization outcomes from all sources, including carrier reimbursement exception reporting and follow up pending prior authorization analysis and denials management.
• Represent organizational projects and assist management with follow-through and implementation of initiatives.
• Manage all aspects of the prior authorization department including the timely, accurate submission and collection of all patient and customer accounts.
• Works with across departments to manage the entire process from insurance verification to final collection.
• Responsible for the timely accurate submission of all prior authorizations for service to the responsible payer.
• Ensure that all payers needing prior authorization are set up correctly within the software system.
• Monitors and validates adherence to Policies and Procedures, auditing as necessary. Monitors and evaluates employee productivity and performance to goal.
• Builds employee morale, motivation and loyalty by fostering positive working relationships.
• This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job.

QUALIFICATIONS:

• Bachelor’s Degree in related field or equivalent experience required
• Minimum of 5 years of experience in managing a high volume, fast growing billing office within the laboratory setting is preferred.
• Extensive knowledge of reimbursement, billing, coding and compliance regulations is required.

REQUIRED KNOWLEDGE, SKILLS AND RESPONSIBILITIES:

• Experience in training in fields such as business administration, accountancy, sales, marketing, computer sciences or similar vocations.
• Two (2) years of experience in prior authorization and insurance billing.
• Ability to perform complex analysis and discuss with upper management.
• Ability to communicate effectively both orally and in writing.
• Strong interpersonal skills and organizational skills, including attention to detail.
• Knowledge of payer eligibility and benefits.
• Experience in healthcare research and analysis skills sufficient to support payer research healthcare policy library and state management.
• Ability to resolve associate issues effectively and efficiently.

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