Prior Authorization Manager

Company: Change Healthcare
Location: Hartford
Posted on: August 6, 2022

Job Description:

Prior Authorization Manager Job Profile SummaryWe are looking to hire a Prior Authorization Manager to join and manage the team. The person in this role will oversee the daily operations for prior authorization management activities for multiple markets designed to achieve quality and service driven objectives. This is a remote position.What will be my duties and responsibilities in this job?+ Manages and optimizes workflows to achieve successful operational and quality outcomes and benefit maximization within the scope of responsibilities.+ Serves as an instrumental partner with internal clients in monitoring and tracking key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.+ Provides guidance for prior authorization management for future expansion and growth efforts.+ Maintain a current knowledge base related to insurance requirements for prior authorization. Serve as primary resource on prior authorization requirements+ Provide detailed departmental operating specifics and work with Technical Services in the design of new systems & programs+ Analyze denial and adjustment reports and recommend changes to workflow as appropriate. Report metrics/trends to internal/external clients+ Perform cost benefit and needs analysis of existing/potential clients to meet their needs+ Establish, develop, and maintain positive business and customer relationships+ Present, promote and assist with marketing of authorization automation tools for potential & current client base+ Ability to lead, participate in Sales/Marketing discussions related to Authorization Service Product delivery & Automation What are the requirements? + 5 years of experience in Authorization/Utilization Management Services+ 2-3 years leadership experience in Utilization Management or Authorization Services+ 2-3 years Revenue Cycle experience preferred+ Experience in Authorization Services Product Management and/or Marketing preferred What critical skills are needed for you to consider someone for this position? + Knowledge of CPT and ICD coding highly desired+ Knowledge of Medicare and third-party payer regulations and guidelines highly desired+ Proficiency in PC software, especially word processing and spreadsheet programs+ Experience with a healthcare based computer system (ex: Epic, Cerner, etc)+ Ability to effectively manage multiple demands, working under moderate to high degree of pressure + Ability to multi-task and problem solve with strong organizational skills+ Excellent leadership skills and strong decision making and self-motivation skills What other skills/experience would be helpful to have? + Preferred Bachelor's Degree in Healthcare or Business or equivalent years of experience. How much should I expect to travel? +

Keywords: Change Healthcare, Hartford , Prior Authorization Manager, Executive , Hartford, Connecticut