Manager, Prior Authorization
Mass General Brigham
Summary
Responsible for overseeing the prior authorization and referral teams who authorize services in accordance with company policies and procedures.
Job description
Job Summary
Responsible for overseeing the prior authorization and referral teams who authorize services in accordance with company policies and procedures.
Essential Functions
- Leads the prior authorization and referral team, including hiring, training, and evaluating staff performance.
- Oversees insurance verification, authorization, and referral procurement/verification processes to ensure timely and accurate patient information.
- Implements and monitors policies and procedures to maintain compliance with regulatory and payer requirements, including authoring departmental standard-of-work documents.
- Collaborates with clinical and administrative teams to resolve prior authorization issues that impact patient care or billing.
- Analyzes authorization metrics to identify trends and opportunities for process improvements.
- Mentors and develops team members through annual performance reviews, scheduled touch bases, and goal planning.
- Develops and delivers training programs to enhance staff knowledge of insurance guidelines and authorization requirements.
Qualifications
Education: Bachelor's Degree in Healthcare Administration, Business Administration, or related field required. Experience in lieu of a degree accepted.
Experience: 5-7 years in revenue cycle operations or financial clearance required; 2-3 years in a management role required; 2-3 years Epic experience preferred.
Knowledge, Skills and Abilities
- Strong knowledge of insurance verification, billing practices, and healthcare regulations.
- Strong leadership and team management abilities.
- Proficiency in revenue cycle management and financial clearance processes.
- Excellent analytical skills to assess and improve operational performance.
- Exceptional communication and interpersonal skills for engaging with staff and patients.
- Ability to manage multiple priorities and work in a fast-paced healthcare environment.
- Attention to detail and a commitment to accuracy in financial processes.
Additional Job Details
- M-F Eastern Business hours required for remote role
- A quiet, secure, stable, HIPAA-compliant workstation is required.
Requirements
- Bachelor's Degree in Healthcare Administration, Business Administration, or related field (or equivalent experience)
- 5-7 years experience in revenue cycle operations or financial clearance
- 2-3 years experience in a management role
- Strong knowledge of insurance verification, billing practices, and healthcare regulations
- Strong leadership and team management abilities
- Proficiency in revenue cycle management and financial clearance processes
- Excellent analytical skills
- Exceptional communication and interpersonal skills
- Ability to manage multiple priorities in a fast-paced healthcare environment
- Attention to detail and accuracy in financial processes
- Epic experience (preferred)
Benefits
- Comprehensive benefits
- Career advancement opportunities
- Differentials
- Premiums
- Bonuses
- Recognition programs
Company overview
Mass General Brigham is one of the largest integrated healthcare delivery systems in the United States, formed through the merger of Massachusetts General Hospital and Brigham and Women's Hospital. Based in Boston, Massachusetts, this academic medical center system operates multiple hospitals, specialty facilities, and community health centers throughout New England. The organization is renowned for its world-class patient care, cutting-edge medical research, and comprehensive medical education programs. As a teaching affiliate of Harvard Medical School, Mass General Brigham trains the next generation of healthcare professionals while advancing medical science through groundbreaking research initiatives. The system provides a full continuum of healthcare services, from primary care and preventive medicine to complex specialty treatments and emergency services. With a focus on innovation and patient-centered care, Mass General Brigham consistently ranks among the top hospital systems in the nation for clinical excellence and research output.