Position Title:    Prior Authorization Manager

Supervisor:         Revenue Cycle Manager

FLSA Status:       Exempt

Mission:

To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.

Values:

Innovation

Integrity

Patient Experience

Teamwork

Job Summary:

• 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.

Supervisory Responsibility:

• Oversees and effectively manages all department specialty tasks, workloads and schedules.
• Interviews, trains, and supervises the prior authorization staff.

Qualifications:

• Associate’s Degree required. Bachelor’s Degree preferred.
• Minimum of 6 months of experience in Prior Authorizations.
• 1 year of experience in a supervisory role strongly preferred.

Skills & Abilities:

• 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.

Work Environment:

While performing the duties of this job, the employee regularly works in an office setting.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must occasionally lift or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Compensation & Work Schedule:

• Full-time: 40 hours/week
• Exempt
• Day Shift: Monday - Friday
• No evenings or weekends.
• A competitive benefits package including medical, dental, vision, disability, and life insurance, 401(k) Plan, PTO time, paid holidays, and HSA plan is offered.

No Phone Calls, Please!

All applicants must be legally authorized to work in the United States at the time of hire. Twin Cities Pain Clinic does not provide employment visa sponsorship for this position.

JOB CODE: 1000238