[Hiring] Manager, Prior Authorizations @Kestra Medical Technologies Inc.

Role Description

This leadership position is accountable for overseeing all aspects of the organization’s prior authorization team and processes including timely and accurate prior authorization submission and appeal, identifying clinical relevance within each order as it relates to Local Coverage Determination, communicating outcomes timely and effectively, trending, and achieving targeted metrics to optimize outcomes. This leader will also be responsible for overseeing and managing the organization’s third-party vendor relating to aspects of the prior authorization process and will monitor and validate adherence to Policies and Procedures.

• Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions.
• Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate.
• Work across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination.
• Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization.
• Ensure that all metrics are achieved and develop actionable plans that will quickly and efficiently resolve deficits should those occur.
• Provide department orientation and ongoing training for all in/direct reports.
• Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains.
• Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage.
• Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results.
• Adhere to Pledge of Confidentiality.
• Information regarding a patient of this company shall not be released to any source outside of this company without the signed permission of the patient.
• All Team Members will not discuss patient cases outside the office or with anyone not employed by this company unless they are directly involved with the patient’s case.

Qualifications

• Bachelor’s degree.
• 3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management.
• Strong understanding of clinical review and prior authorization management.
• Proven record of achieving aggressive metrics and outcomes.
• Preferred: 10+ years of leading revenue cycle management functions.
• Experience in vendor management or offshore staff augmentation relationships.

Requirements

• Directly manage Prior Authorization team members including but not limited to conducting performance reviews, providing feedback, and helping to set professional development goals.

Work Environment

• Remote, yet fast-paced work environment.
• Extended hours when needed.

Physical Demands

• Frequent repetitive motions that may include wrists, hands and/or fingers, such as keyboard and mouse usage.
• Frequent stationary position, often sitting for prolonged periods of time.
• Occasional bending and stooping.
• Occasional lifting up to 20 pounds.

Travel

• Occasional travel, less than 10%.

Benefits

• Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc.
• Pay equity is an important part of Kestra’s Culture.
• Salary: Annualized at $100,000 - $120,000 plus bonus, depending on experience.