Prior Authorization Manager

Sage Infusion•Tampa, FL

2d•Remote

About The Position

Sage Infusion is a rapidly growing infusion center with locations in central and southwest Florida. At Sage, we’ve reimagined patient care. From a quick start, to upfront pricing and financial assistance, to compassionate care by our clinical experts in a serene environment, patient experience infusion therapy like never before. The Prior Authorization Manager plays a pivotal leadership role in managing and enhancing the prior authorization process for infusion services. This position is responsible for ensuring the accurate and timely submission and follow-up of prior authorization requests, optimizing reimbursement outcomes, and reducing claim denials. The ideal candidate possesses deep expertise in payer policies, infusion therapy protocols, and demonstrated experience in team leadership and cross-departmental collaboration. Will be a remote position with the expectation to do a monthly meeting at our St. Pete office.

Requirements

Bachelor’s degree in Healthcare Administration, Nursing, Business, or related field
5+ years of experience in healthcare operations, with at least 2 years in a supervisory role
Strong knowledge of medical terminology, insurance processes, specialty pharmacy, and healthcare regulations.
Experience with insurance portals and prior authorization submission.
Excellent leadership and team management skills, virtual team leadership is a bonus.
Strong problem-solving and analytical abilities
Proficiency in healthcare software and Microsoft Office Suite
Experience in customer service and conflict resolution

Nice To Haves

Familiarity with infusion therapy or specialty pharmacy preferred

Responsibilities

Provide leadership and oversight to the Prior Authorization team, ensuring the efficient acquisition of insurance approvals for infusion therapies.
Oversee and provide expert guidance on prior authorizations for Alzheimer’s Disease therapies and other high-risk denial medications, ensuring robust clinical documentation, payer-criteria alignment, proactive appeals management, and minimized treatment delays for vulnerable patient populations.
Develop, implement, and continuously refine standardized workflows to streamline the prior authorization process and ensure compliance with payer guidelines.
Design and implement strategies to prevent prior authorization denials, including root-cause analysis of denial trends and continuous process improvement.
Ensure adherence to new and existing metrics related to PA approvals, turnaround times, denial rates, and appeal status.
Routinely review authorization workflows within the WeInfuse system to prevent backlogs on initial, pending or expiring authorization submissions.
Collaborate proactively with Lead Insurance Support Specialists (ISS) to resolve authorization-related questions or issues across all locations.
Monitor daily operations, manage workload distribution, and track performance metrics to ensure timely and accurate authorization submissions.
Maintain up-to-date knowledge of payer-specific requirements, including Medicare Advantage plans and various commercial insurance plans.
Act as the primary escalation point for complex or delayed authorization issues, ensuring prompt resolution.
Coordinate with Intake, Clinical and Claims teams to support seamless and timely patient care.
Train, mentor and support professional development of Prior Authorization team members.
Lead monthly meetings with the Associate Director of Revenue Cycle Management to address pending patient authorizations, resolve team challenges, and promote interdepartmental collaboration.
Analyze trends in claims denials and partner with leadership to implement corrective strategies and process improvements.
Evaluate workflow efficiency, pilot new technologies or software as needed, and provide regular feedback to leadership.
Maintain and update key departmental documents, including the Prior Authorization Policy, Prior Auths spreadsheet and other reference materials, communicating updates to the team promptly.
Ensure full compliance with HIPAA and all relevant regulatory standards through proper documentation and process oversight.