Manager, Prior Authorizations
About the role
The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignity. Innovating versatile new ways to deliver care, Kestra is helping patients and their care teams harmoniously monitor, manage, and protect life.
Responsibilities
- 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
Qualifications
- Bachelor’s degree
- 10+ years of leading revenue cycle management functions
- Experience in vendor management or offshore staff augmentation relationships
Skills
- Passion: Contagious excitement about the company – sense of urgency
- Commitment: Commitment, accountability, and dedication to the highest ethical standards
- Collaboration/Teamwork: Inclusion of Team Member regardless of geography, position, and product or service
- Action/Results: High energy, decisive planning, timely execution
- Innovation: Generation of new ideas from original thinking
- Customer Focus: Exceed customer expectations, quality of products, services, and experience always present of mind
- Emotional Intelligence: Recognizes, understands, manages one’s own emotions and is able to influence others. A critical skill for pressure situations.
Benefits
Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc. Pay equity is an important part of Kestra’s Culture. Our compensation ranges are guided by national and local salary surveys and take into consideration experience level and internal equity. Each role is benchmarked based on the job description provided. If your qualifications and/or experience level are outside of the posted position, we encourage you to apply as we are growing fast and roles that are coming soon may not be posted. Salary: Annualized at $100,000 - $120,000 plus bonus. Depending on experience.
Schedule
Remote, yet fast-paced work environment. Extended hours when needed. Occasional travel, less than 10%. Occasional lifting up to 20 pounds.
Pay
Annualized at $100,000 - $120,000 plus bonus. Depending on experience.