Insurance and Prior Authorization Manager

Responsibilities

• Maintain positive leadership and give frequent performance feedback to team members and invite two-way communication.
• Coach established employees when needs are identified, holding employees accountable for results through coaching and development of action plans.
• Monitor Prior Authorization and Eligibility automation processes.
• Aid IT team in developing new automation processes for authorization submission/tracking and insurance verification.
• Collaborate with billing team for claim denials related to authorization and eligibility.
• Produce productivity and error reports to assess staff.
• Prioritize work to maximize turn-around time.
• Contact insurance plans to determine eligibility and obtain coverage and benefit information.
• Contact insurance plans to obtain prior authorization for services.
• Document findings thoroughly and accurately.
• Train organizational staff on procedures for requesting, documenting, and processing prior authorizations.

Requirements

• High school diploma or equivalent required.
• Bachelor’s degree with specialization in health information administration preferred.
• 3 years medical authorization experience required.
• Strong background and experience in Revenue Cycle Management preferred.
• 2+ years in a leadership role required.
• Active knowledge of CMS guidelines, contracted insurance guidelines, and coding policies.
• Excellent verbal and written communication skills.
• Demonstrated computer literacy and excellent math skills.
• Ability to maintain a high level of confidentiality and professionalism.