Job Description:
• Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions
• Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate
• Work across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination
• Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization
• Ensure that all metrics are achieved and develop actionable plans that will quickly and efficiently resolve deficits should those occur
• Provide department orientation and ongoing training for all in/direct reports
• Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains
• Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage
• Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results
• Adhere to Pledge of Confidentiality
Requirements:
• Bachelor’s degree
• 3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management
• Strong understanding of clinical review and prior authorization management
• Proven record of achieving aggressive metrics and outcomes
Benefits:
• Medical
• Dental
• 401K with Match
• Pay equity initiatives