Prior Authorization Manager

Twin Cities Pain Clinic • Edina, MN

1d • Onsite

About The Position

Effectively manages staff and their performance to meet metrics related to our prior authorization processes for clinic injections, ambulatory surgical center surgeries and procedures, physical therapy, imaging, durable medical equipment, Workman’s Compensation, and neuromodulation authorizations. Maintains key metrics while holding staff accountable to meet and report on department expectancies and identifies key process improvements actions. Expert resource for patients and providers in determining patient authorization needs and medical necessity guidelines. Develops learning strategies and resources for the department and company to stay up to date with insurance, state, and federal guidelines, including but not limited to, medical policies, CPT codes, ICD-10 codes, FDA regulations and protocols. Collaborates with insurance companies, including but not limited to, Commercial payers, Medicaid, Medicare, Worker’s Compensation, and Auto insurance adjustors to obtain necessary authorizations and resolve case matters. Coordinates front-end denials and appeals, including but not limited to, injection denials, surgery denials, imaging denials, Workman’s Compensation denials, and DME denials. Provides in-depth analysis of monthly, quarterly, and yearly procedure and production trends and presents at meetings where appropriate. Identifies key issues and collaborates with individuals and departments needed to resolve these matters. Inbound/outbound calls to insurance companies, physicians’ offices, and patients. Determines appropriate scheduling locations for procedures and surgeries based on patient’s insurance, physician, and facility needs. Assists billing office with back-end appeals and audits related to prior authorization errors and medical necessity denials Performs a variety of other administrative duties to meet the department and company’s needs. Completes other duties as assigned.

Requirements

• Associate’s Degree required.
• Minimum of 6 months of experience in Prior Authorizations.
• Detail oriented with ability to manage multiple priorities.
• Strong verbal and written communication skills.
• Demonstrated leadership ability.
• Strong knowledge of insurance and eligibility.
• Ability to problem solve.
• Proficient computer and business skills.
• Self-directed, reliable, consistent.
• Ability to be a professional representative of the company.
• Ability to follow directives as presented by your supervisor.
• Ability to follow company policies and procedures.
• Ability to abide by all HIPAA privacy laws.

Nice To Haves

• Bachelor’s Degree preferred.
• 1 year of experience in a supervisory role strongly preferred.

Responsibilities

• Effectively manages staff and their performance to meet metrics related to our prior authorization processes for clinic injections, ambulatory surgical center surgeries and procedures, physical therapy, imaging, durable medical equipment, Workman’s Compensation, and neuromodulation authorizations.
• Maintains key metrics while holding staff accountable to meet and report on department expectancies and identifies key process improvements actions.
• Expert resource for patients and providers in determining patient authorization needs and medical necessity guidelines.
• Develops learning strategies and resources for the department and company to stay up to date with insurance, state, and federal guidelines, including but not limited to, medical policies, CPT codes, ICD-10 codes, FDA regulations and protocols.
• Collaborates with insurance companies, including but not limited to, Commercial payers, Medicaid, Medicare, Worker’s Compensation, and Auto insurance adjustors to obtain necessary authorizations and resolve case matters.
• Coordinates front-end denials and appeals, including but not limited to, injection denials, surgery denials, imaging denials, Workman’s Compensation denials, and DME denials.
• Provides in-depth analysis of monthly, quarterly, and yearly procedure and production trends and presents at meetings where appropriate.
• Identifies key issues and collaborates with individuals and departments needed to resolve these matters.
• Inbound/outbound calls to insurance companies, physicians’ offices, and patients.
• Determines appropriate scheduling locations for procedures and surgeries based on patient’s insurance, physician, and facility needs.
• Assists billing office with back-end appeals and audits related to prior authorization errors and medical necessity denials
• Performs a variety of other administrative duties to meet the department and company’s needs.
• Completes other duties as assigned.
• Oversees and effectively manages all department specialty tasks, workloads and schedules.
• Interviews, trains, and supervises the prior authorization staff.

Benefits

• A competitive benefits package including medical, dental, vision, disability, and life insurance, 401(k) Plan, PTO time, paid holidays, and HSA plan is offered.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree