Director of Outpatient Authorizations and Referrals
Job Location:
Somerville, NJ - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
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
Bachelors Degree in Healthcare Administration Business Finance or related field of study required
Masters 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.
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$124342.40 - $180897.60/AnnualGrade
9EEO Statement:
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Director
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
