Prior Authorization Manager

Responsibilities

• Work with our Prior Authorizations vendor to resolve complex authorization issues including coordinating with our providers, patients and payors
• Be the inhouse expert for all prior authorizations and pre-certification requests and requirements for a region or set of payors
• Support the team in chasing down documentation, resolving auth rejections, and navigating payer requirements
• Work with the operations team to identify bottlenecks, inefficiencies, and opportunities across the intake workflow
• Develop processes and training materials for offshore team members to resolve day-to-day prior authorization issues
• Own Prior Authorization outcomes and KPIs for your region / payors

Qualifications

• 5+ years of experience in ABA intake with a specific focus on Prior Authorizations or Insurance Certification
• Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
• Highly organized and relentless about follow-through, nothing falls through the cracks on your watch
• Extreme detail orientation and ability to read complex clinical documents, payor feedback, and EHR data with regards to prior authorization workflows
• Communicate clearly and confidently with everyone from parents to clinicians to payor contacts
• Are a problem-solver - you identify the issue and fix it
• Comfortable with ambiguity and can make good judgment calls in real time
• Hold yourself to a high bar while remaining approachable and supportive