Manager, Prior Authorization
Job Location:
Somerville, NJ - USA
Yearly 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 prior authorization and referral teams who authorize services in accordance with company policies and procedures.Essential Functions
-Leads the prior authorization and referral team including hiring training and evaluating staff performance.
-Oversees insurance verification authorization and referral procurement/verification processes to ensure timely and accurate patient information.
-Implements and monitors policies and procedures to maintain compliance with regulatory and payer requirements including authoring departmental standard-of-work documents.
-Collaborates with clinical and administrative teams to resolve prior authorization issues that impact patient care or billing.
-Analyzes authorization metrics to identify trends and opportunities for process improvements.
-Mentors and develops team members through annual performance reviews scheduled touch bases and goal planning.
-Develops and delivers training programs to enhance staff knowledge of insurance guidelines and authorization requirements.
Qualifications
Education
Bachelors Degree Healthcare Administration required or Bachelors Degree Business Administration required or Bachelors Degree Related Field of Study required
Can this role accept experience in lieu of a degree
Yes
Experience
Experience in revenue cycle operations or financial clearance 5-7 years required and Experience in a management role 2-3 years required and Epic experience 2-3 years preferred
Knowledge Skills and Abilities
- Strong knowledge of insurance verification billing practices and healthcare regulations.
- Strong leadership and team management abilities.
- Proficiency in revenue cycle management and financial clearance processes.
- Excellent analytical skills to assess and improve operational performance.
- Exceptional communication and interpersonal skills for engaging with staff and patients.
- Ability to manage multiple priorities and work in a fast-paced healthcare environment.
- Attention to detail and a commitment to accuracy in financial processes.
Additional Job Details (if applicable)
M-F Eastern Business hours required for remote role
A quiet secure stable HIPPA-compliant workstation is required.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$79560.00 - $115720.80/AnnualGrade
7EEO 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:
Manager
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.
