Manager, Prior Authorizations

Kestra Medical Technologies Inc.

11h•$100,000 - $120,000•Remote

About The Position

This leadership position is accountable for overseeing all aspects of the organization’s prior authorization team and processes including timely and accurate prior authorization submission and appeal, identifying clinical relevance within each order as it relates to Local Coverage Determination, communicating outcomes timely and effectively, trending, and achieving targeted metrics to optimize outcomes. This leader will also be responsible for overseeing and managing the organization’s third-party vendor relating to aspects of the prior authorization process and will monitor and validate adherence to Policies and Procedures.

Requirements

Bachelor’s degree
3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management
Strong understanding of clinical review and prior authorization management
Proven record of achieving aggressive metrics and outcomes

Nice To Haves

Bachelor’s degree
10+ years of leading revenue cycle management functions
Experience in vendor management or offshore staff augmentation relationships

Responsibilities

Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions
Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate
Work across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination
Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization
Ensure that all metrics are achieved and, develop actionable plans that will quickly and efficiently resolve deficits should those occur
Provide department orientation and ongoing training for all in/direct reports
Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains
Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage
Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results
Adhere to Pledge of Confidentiality
Information regarding a patient of this company shall not be released to any source outside of this company without the signed permission of the patient. Furthermore, information will only be released internally on a needto-know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by this company unless they are directly involved with the patient’s case.