Prior Authorization Manager Dermatology

Job Description

Join Our Team at Skin and Cancer Institute!

Are you passionate about dermatology and skin health? Do you thrive in a dynamic, patient-focused environment? Skin and Cancer Institute is looking for dedicated professionals to join our team!

SUMMARY OF POSITION

This position manages and oversees the overall policies, objectives, and initiatives of an organization's revenue cycle activities to optimize the patient financial interaction along the care continuum. The Prior Authorization Manager partners with patients and providers regarding authorization requests and updates to patient records, oversees prior authorization department including extended department vendors, and implements best practices to maximize Revenue, all with a focus on process, communication, and team effort

ESSENTIAL DUTIES

Maintain current knowledge of insurance policies, regulations, and requirements to ensure compliance with industry standards.

Leads business process improvement efforts in collaboration with clinical, operational, growth and IT counterparts to develop automated, repeatable processes and systems to optimize revenue collection.

Interview/train/and review departmental staff.

Reports essential KPI’s to senior leadership to ensure departmental goals are being met.

Direct oversight of internal and extended department ensuring workflows and processes are being completed accurately and efficiently.

Review patient medical records and insurance information to determine which services require authorization.

Coordinate with healthcare providers and insurance companies to obtain pre-authorization for medical procedures, treatments, and medications.

Independently identifies and pursues revenue improvement opportunities through process improvement and data management.

Communicate with patients and healthcare providers regarding the status of authorization requests and any changes in coverage.

Participates in the development of coding and billing strategies, evaluating processes related to Revenue Cycle and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors).

Maintains professional relationships and collaborates across teams, managing projects, facilitating meetings and presenting in various settings, including senior leadership.

Prepares and coordinates revenue cycle responsibilities within the acquisition/implementation process.

This includes but is not limited to staff onboarding, vendor management, and clearinghouse management.

SKILLS/QUALIFICATIONS/EXPERIENCE

4+ years experience in Prior Authorization processes in a business office/remote setting.

3+ years experience in a Prior Authorization leadership role.

Bachelor’s degree in related field preferred but not required.

Must have a high school diploma or equivalent certificate.

Demonstrate an understanding of healthcare management, including staffing and leadership.

Demonstrate an understanding of patient accounts.

Ability to educate patients on explanation of benefits for insurance processed claims.

Communicate effectively with healthcare workers, patients and insurance companies.

Able to prioritize and organize tasks at hand.

Strong attention to detail, positive attitude and a proven ability to lead a team to success.

Proficient in Microsoft Word, Outlook and Excel.

Knowledge of state regulations.

Presentation skills are desirable.

Must have excellent written and verbal communication skills.

Able to work with a diverse group of people.

Must be able to work in a fast-paced office environment.

Other duties as assigned.

POSITION REQUIREMENTS

To perform effectively in this position, the incumbent must have:

Bachelors degree in related field is highly preferred.

5+ years of related experience required.

Proficiency in Microsoft Office with advanced Excel skills.

Experience with Intacct, ConnectWise, Ubersmith, System Integration and M&A a plus.

Strong communication skills, written and verbal.

Ability to work independently and manage time appropriately.

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Full-time