Project Manager, Authorizations

PRIMARY RESPONSIBILITIES:

• Track/monitor all cases requiring true prior authorization.
• Create/provide weekly updates to leadership on all pending/processed cases.
• Participate in submission, follow up, and performing necessary action on adverse decisions of prior authorization requests.
• Provide strong, timely financial and business analytics for decisions by organizational stakeholders
• Develop actionable roadmaps for improving workflows and processes.
• Performs in-depth reviews/audits to identify issues/trends and create remediation plan(s).
• Support management of projects to ensure successful and timely completion.
• Support management in monitoring and tracking adherence of SOPs, SLA , productivity and quality standards set by leadership
• Evaluate key performance indicators, provide ongoing reports, and recommend business plan updates.
• Performs a wide range of analytics functions in a fast-paced team environment using tools such as Excel, Power BI and other business intelligence tools.
• Analyzes payer and product prior authorization, denial, and reimbursement trends.
• Designs and executes improvement projects.
• Conducts complex data analysis and data interpretation.
• Meets established deadlines timely, accurately, and with a sense of urgency.
• Supervise team including monitoring production and quality to specified goals.
• Assists with feedback for hiring, discipline and performance evaluations.
• Oversees the process of providing coverage in a production environment.
• Provides department orientation for all direct reports and coordinates training per job description.
• Ensures that on-going training is provided for established employees, including the development & maintenance of standard operating procedures.
• Liaisons with internal departments to promote ongoing communication and ensure accuracy.
• Acts as an escalated level of response for concerns and complaints.
• Assists staff with enforcing policy.
• Works with cross functional teams to manage the entire process from insurance verification to final collection of prior authorization.
• Monitors and validates adherence to policies and procedures, auditing as necessary.
• Completes projects and reports in a timely fashion on a daily, weekly or monthly basis per the direction of management.
• Develops, monitors, coaches, and manages staff, ensuring the development of employees through orientation, training, establishing objectives, communication of rules and constructive discipline.
• Promotes a positive working environment through role modeling, team development, respect, and being fair and consistent.

QUALIFICATIONS:

• Bachelor’s degree or equivalent experience. 
• Minimum of 3 years of experience in managing a high volume, fast growing billing office within the laboratory setting is preferred.
• Bi-lingual (fluent in Spanish).
• Previous experience
• Minimum 5 years of experience with prior authorization submission and revenue cycle management software.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Thorough knowledge of healthcare reimbursement (government and private payers) including coverage, coding and payment and understanding of insurance billing practices.
• Demonstrated ability to develop and analyze payments, diagnose issues, and present findings to management.
• Must be able to communicate effectively both orally and in writing. Strong interpersonal skills.
• Strong organizational skills; attention to detail.
• Ability to proficiently use a computer and standard office equipment.
• Working knowledge of Microsoft Office.
• Previous experience with Google Enterprise Suite – Gmail, Slides, Sheets, Docs, Drive.
• Knowledge of payer eligibility and benefits. Health care research and analysis skills sufficient to support payer research healthcare policy library and state management.
• Conflict resolution skills. Must be able to resolve employee issues effectively and efficiently.