Director of Outpatient Authorizations and Referrals

Job Summary

Responsible for overseeing the financial clearance operations to ensure patient eligibility, benefits verification, and authorization processes are accurately managed. Ensures efficient and compliant financial clearance workflows that support revenue cycle goals and improve the patient experience.

Essential Functions

• Leads financial clearance operations, including eligibility verification, benefits coordination, and prior authorization processes.
• Collaborates with patient access, billing, and managed care teams to optimize workflows and reduce delays.
• Develops and implements policies to ensure compliance with regulatory requirements and payer guidelines.
• Monitors financial clearance performance metrics, identifying and addressing areas for improvement.
• Manages relationships with payers and other stakeholders to resolve issues related to coverage and authorizations.
• Oversees the training and development of financial clearance staff, fostering a knowledgeable and service-oriented team.
• Analyzes trends in denials and authorizations, developing strategies to minimize financial risk.
• Prepares reports for senior leadership on financial clearance activities and performance.
• Ensures the accuracy and efficiency of data collection and documentation for patient financial records.

Qualifications

Education

• Bachelor's Degree in Healthcare Administration, Business, Finance or related field of study required
• Master's Degree in a related field of study preferred

Experience

• 8+ years of experience required in financial clearance, revenue cycle management, contract management, or other closely related role, preferably in a managed care setting
• 5+ years of experience in a management or leadership role required

Knowledge, Skills and Abilities

• Strong understanding of payer regulations, authorizations, and managed care requirements.
• Proficiency in healthcare revenue cycle processes and systems.
• Analytical skills to assess financial data and operational metrics.
• Effective communication and collaboration skills to work with cross-functional teams and external partners.
• Leadership abilities for team management and staff development.

Pay

Pay Range $124,342.40 - $180,897.60/Annual Grade 9