Insurance and Prior Authorization Manager

USA Vein Clinics, Vascular, Fibroid and Oncology Centers; Northbrook (IL); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Health

Dental

Vision

PTO

401k

Job summary

USA Clinics Group is seeking an Insurance and Prior Authorization Manager to lead a team that supports physicians and the revenue cycle. You will oversee documentation, authorization and eligibility processes, driving efficiency and accuracy in a fast-paced outpatient setting.

Responsibilities include monitoring team performance, coaching staff, coordinating with IT for automation, and collaborating with billing on denials related to authorization.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree in health information administration preferred.
• 3 years medical authorization experience required.
• Strong background in Revenue Cycle Management preferred.
• Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Ability to lead a team with positive attitude and effective communication.

Responsibilities

• Monitor productivity and performance of the team and report to Senior Leadership.
• Provide frequent feedback and foster two-way communication with staff.
• Coach employees and implement action plans for improvement.
• Oversee prior authorization and eligibility automation processes.
• Assist IT in developing automation for authorization submission and insurance verification.
• Collaborate with billing to address claim denials related to authorization and eligibility.
• Produce reports on productivity and errors to identify improvement opportunities.
• Prioritize work to maximize turnaround time.
• Coordinate with insurance plans for eligibility and coverage information.
• Obtain prior authorization for services as needed.
• Document findings thoroughly and accurately.
• Train staff on requesting, documenting, and processing prior authorizations.

Skills

Leadership

Communication

CMS guidelines

Coding policies

Revenue Cycle Management

Prior Authorization

Education

Bachelor's degree in health information administration

High school diploma or equivalent

Job description

Why USA Clinics Group?

Founded by Harvard-trained physicians with a vision of offering patient-first care beyond the hospital settings, we\'ve grown into the nation\'s largest network of outpatient vein, fibroid, vascular, and prostate centers, with 170+ clinics across the country. Our mission is simple: deliver life-changing, minimally invasive care, close to home.

Founded by Harvard-trained physicians with a vision of offering patient-first care beyond the hospital settings, we\'ve grown into the nation\'s largest network of outpatient vein, fibroid, vascular, and prostate centers, with 170+ clinics across the country. Our mission is simple: deliver life-changing, minimally invasive care, close to home.

We\'re building a culture where innovation, compassion, and accountability thrive. While proud of our growth, we\'re even more excited about what\'s ahead, and the team we\'re building to get there. We look forward to meeting you!

Why You\'ll Love Working with us:

Rapid career advancement Competitive compensation package

Positive, team-oriented environment Work with cutting-ed technology

Make a real impact on patients\' lives Join a fast-growing, mission-driven company

Insurance and Prior Authorization Manager

USA Clinics Group is looking for an Insurance and Prior Authorization Manager to join our team! The Insurance and Prior Authorization Manager will collaborate with physicians, SVP of Revenue Cycle, and other members of the management team. They will serve as a critical link between providers, payers, and patients; and will directly oversee and manage the following employees:

• Clinical documentation improvement specialists
• Administrative staff and clerks

Position Details:

• Location: Northbrook, IL
• Schedule: Full-Time, Monday-Friday (on-site)
• Compensation: $70,000-$85,000 based on experience and qualifications

Responsibilities

• Monitor and manage productivity and performance of assigned employees including daily/weekly/monthly department metrics to Senior Leadership and provide reporting and action plans for improvement
• Maintains positive leadership and gives frequent performance feedback to team members and invites two-way communication
• Coaches established employees when needs are identified, holding employees accountable for results through coaching and development of action plans
• Monitor Prior Authorization and Eligibility automation processes
• Assist IT team in developing new automation processes for authorization submission/tracking and insurance verification
• Work closely with billing team for claim denials related to authorization and eligibility
• Produces productivity and error reports to assess staff
• Prioritize work to maximize turn-around time
• Contacts insurance plans to determine eligibility and obtain coverage and benefit information
• Contacts insurance plans to obtain prior authorization for services
• Documents findings thoroughly and accurately
• Performs training with organizational staff on procedures for requesting, documenting, and processing prior authorizations
• Additional duties as assigned

Requirements

• High school diploma or equivalent required
• Bachelor's degree with specialization in health information administration preferred
• 3 years medical authorization experience required
• Strong background and experience in Revenue Cycle Management preferred
• 2+ years in a leadership role required
• Active knowledge of CMS guidelines contracted insurance guidelines and coding policies
• Ability to lead a team by demonstrating a positive attitude, openness to change, willingness to help, and respect for others and their ideas
• Excellent verbal and written communication skills
• Detail oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment
• Demonstrated computer literacy and excellent math skills
• Ability to maintain a high level of confidentiality and professionalism

Benefits

• Health
• Dental
• Vision
• PTO
• 401k