PrimEra Medical Technologies
Website:
primeramed.com
Job details:
Job Role: Senior Manager – Prior Authorization
The Prior Authorization Senior Manager is responsible for overseeing the daily operations of the prior authorization department. This role involves leading a team to ensure all required prior authorizations are obtained accurately and in a timely manner for patient services, medications, and procedures. The manager will develop and implement efficient workflows, monitor key performance indicators, ensure compliance with all payer and regulatory requirements, and serve as a key resource for staff and clinical teams. The ultimate goal is to minimize claim denials, reduce delays in patient care, and optimize the revenue cycle.
Key Responsibilities:
Leadership and Team Management:
• Lead, train, and mentor a team of prior authorization specialists.
• Manage daily workflow, delegate tasks, and ensure productivity goals are met.
• Conduct performance reviews, provide constructive feedback, and identify opportunities for professional development. Operational Oversight:
• Oversee the end-to-end prior authorization process for all requested services.
• Develop and implement standard operating procedures (SOPs) to streamline workflows and improve efficiency.
• Monitor and analyze key performance indicators (KPIs) such as approval rates, turnaround times, and denial trends. Compliance and Quality Assurance:
• Ensure all prior authorization activities adhere to federal, state, and payer-specific regulations.
• Conduct regular audits of submitted authorizations to maintain a high level of accuracy and quality.
• Stay current with changes in payer policies, medical necessity criteria, and coding guidelines.
Communication and Collaboration:
• Serve as the primary point of contact for clinical staff and providers regarding prior authorization requirements.
• Collaborate with the billing, coding, and patient financial services departments to resolve complex issues and prevent future denials.
• Communicate with insurance companies and third-party payers to appeal denied authorizations.
Desired Candidate:
• A minimum of 15 years of experience in prior authorization, medical billing, or revenue cycle management.
• At least 5 years of experience in a leadership or supervisory role.
• Prior Authorization Expertise: In-depth knowledge of prior authorization processes for a wide range of medical services and specialties.
• Strong understanding of insurance and third-party payer policies, especially those from major health plans.
• Experience with electronic health records (EHR) systems, prior authorization software, and Microsoft Office Suite.
• Familiarity with HIPAA regulations and other healthcare compliance standards.
• Excellent leadership, communication, and interpersonal skills.
• Strong analytical skills to interpret data, identify trends, and make informed decisions.
• Proven ability to resolve complex issues and manage competing priorities effectively.
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