[Hiring] Manager, Prior Authorization @Mass General Brigham

Role Description

Responsible for overseeing the prior authorization and referral teams who authorize services in accordance with company policies and procedures.

• 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

• Bachelor's Degree in Healthcare Administration or Business Administration or Related Field of Study required.
• Experience in revenue cycle operations or financial clearance: 5-7 years required.
• Experience in a management role: 2-3 years required.
• Epic experience: 2-3 years preferred.
• 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.

Requirements

• M-F Eastern Business hours required for remote role.
• A quiet, secure, stable, HIPAA-compliant workstation is required.

Benefits

• Competitive base pay.
• Comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate contributions and support professional growth.

Company Description

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.