Revenue Verification Manager

Advanced Radiology Consultants•Shelton, CT

About The Position

Advanced Radiology is one of the largest independent radiology practices in the tri-state area with the most experienced radiologists. We look for team members who want to grow and be professionally challenged, while enjoying a rewarding, caring, and friendly environment. We are looking for a Customer Care Representative to join our team. The pay range for this role will depend on experience and qualifications. The Authorization & Verification Manager oversees the day-to-day operations, staff oversight, and quality initiatives of the Revenue Verification Services Department. Working in close partnership with the Director of Finance, this role assists with workflow execution, staff development, authorization oversight, and stakeholder communication to ensure compliance with payer requirements, efficient operations, and accurate reimbursement.

Requirements

Strong working knowledge of healthcare revenue cycle processes, including insurance authorization, eligibility, and medical necessity.
Ability to analyze data, identify trends, and escalate improvement opportunities.
Intermediate to advanced proficiency in Microsoft Office applications.
Strong attention to detail and organizational skills.
Effective verbal and written communication skills across all stakeholder levels.
Experience supporting training initiatives and workflow implementation.
Bachelor’s degree required
Minimum seven years healthcare experience with demonstrated knowledge of insurance processes, authorization workflows, and payer medical policies related to diagnostic examinations and procedures.

Nice To Haves

master’s degree preferred

Responsibilities

Responsible for the creation, updating, implementation, and maintenance of departmental workflow guidelines in alignment with payer policies, prior authorization, and medical necessity requirements.
Oversee ongoing workflow review and optimization in collaboration with the Revenue Verification Supervisor.
Monitor daily work volumes and workflow adherence, identifying gaps or issues requiring follow-up.
Maintain a strong working knowledge of frontline staff processes to support effective workflow implementation and monitoring.
Analyze QA data to identify trends, training needs, and workflow improvement opportunities
Accountable for resolving authorization and account verification issues that impact scheduled examinations.
Oversee operational reviews with clinical staff and leadership and help execute approved workflow improvements.
Monitor staff productivity, quality metrics, and key performance indicators (KPIs).
Identify performance trends and recommend coaching or training interventions.
Support onboarding, training, and ongoing development of Revenue Verification staff.
Participate in employee performance evaluations in coordination with the Revenue Verification Supervisor.
Communicate workflow updates, procedural changes, and policy revisions through meetings, written communications, and follow-up guidance.
Ensure staff understanding and compliance through clarification, coaching, and reinforcement.
Monitor authorization and medical necessity denials by category and staff member.
Track issues that require corrective action or additional training to reduce denials and rework.
Participate in department-led quality improvement initiatives.
Escalate complex, time-sensitive, or high-impact issues to appropriate leadership.
Support quality assurance efforts to ensure adherence to departmental standards and payer requirements.
Serve as a point of contact for internal teams and external stakeholders regarding authorization-related issues.
Communicate with Site Managers when denials or delays may impact patient appointments.
Support positive relationships with referring providers, including VIP referrals, through timely issue resolution.
Coordinate with the Marketing Team on referral feedback and service recovery efforts as needed.
Contribute to maintaining high levels of referring physician and patient satisfaction.
Support the Senior Revenue Cycle Manager with reporting, volume tracking, and operational issue resolution.
Participate in leadership meetings to review performance trends, challenges, and progress.
Maintain regular communication with the Revenue Verification Supervisor regarding staffing coverage and workload balance.
Demonstrate professionalism, accountability, adaptability, and teamwork as a leadership role model.
Contribute ideas for process improvement and support implementation of leadership-approved initiatives.