Insurance and Prior Authorization Manager

USA Clinics Group•Northbrook, IL

21h•$70,000 - $85,000•Onsite

About The Position

USA Clinics Group is looking for an Insurance and Prior Authorization Manager to join their team. This role will collaborate with physicians, the SVP of Revenue Cycle, and other management team members. The manager will act as a crucial link between providers, payers, and patients, and will directly oversee clinical documentation improvement specialists and administrative staff and clerks.

Requirements

High school diploma or equivalent required.
3 years medical authorization experience required
2+ years in a leadership role required
Active knowledge of CMS guidelines contracted insurance guidelines and coding policies
Ability to lead a team by demonstrating a positive attitude, openness to change, willingness to help, and respect for others and their ideas
Excellent verbal and written communication skills
Detail oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment
Demonstrated computer literacy and excellent math skills
Ability to maintain a high level of confidentiality and professionalism

Nice To Haves

Bachelor’s degree with specialization in health information administration preferred.
Strong background and experience in Revenue Cycle Management preferred

Responsibilities

Monitor and manage productivity and performance of assigned employees including daily/weekly/monthly department metrics to Senior Leadership and provide reporting and action plans for improvement.
Maintains positive leadership and gives frequent performance feedback to team members and invites two-way communication.
Coaches established employees when needs are identified, holding employees accountable for results through coaching and development of action plans.
Monitor Prior Authorization and Eligibility automation processes
Assist IT team in developing new automation processes for authorization submission/tracking and insurance verification
Work closely with billing team for claim denials related to authorization and eligibility
Produces productivity and error reports to assess staff.
Prioritize work to maximize turn-around time.
Contacts insurance plans to determine eligibility and obtain coverage and benefit information.
Contacts insurance plans to obtain prior authorization for services.
Documents findings thoroughly and accurately.
Performs training with organizational staff on procedures for requesting, documenting, and processing prior authorizations.
Additional duties as assigned.