Insurance & Prior Authorization Leader - PTO & 401(k)

USA Clinics Group; Northbrook (IL); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Health

Dental

Vision

PTO

401(k)

Job summary

USA Clinics Group in Northbrook, IL is seeking an Insurance and Prior Authorization Manager to lead a team including clinical documentation improvement specialists and clerical staff. The role requires close collaboration with physicians, the SVP of Revenue Cycle, and management to ensure efficient authorization processes.

Key duties include monitoring productivity, coaching staff, managing pre-authorization/eligibility automation, and coordinating with IT and billing on denials and workflow

Qualifications

• High school diploma or equivalent is required.
• Bachelor’s degree in Health Information Administration is preferred.
• 3 years medical authorization experience is required.
• Strong background in Revenue Cycle Management is preferred.
• 2+ years in a leadership role is required.
• Active knowledge of CMS guidelines, contracted insurance guidelines, and coding policies.
• Ability to lead a team with a positive attitude and good communication.
• Excellent verbal and written communication skills.
• Detail oriented, reliable, and able to multitask in a fast-paced environment.
• Demonstrated computer literacy and strong math skills.

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.
• Maintain positive leadership and give frequent performance feedback, encouraging two‑way communication.
• Coach employees when needs are identified, holding them accountable 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.
• Produce productivity and error reports to assess staff performance.
• Prioritize work to maximize turn‑around time.
• Contact insurance plans to determine eligibility and obtain coverage and benefit information.
• Contact insurance plans to obtain prior authorization for services.
• Document findings thoroughly and accurately.
• Perform training with organizational staff on procedures for requesting, documenting, and processing prior authorizations.
• Complete additional duties as assigned.

Skills

Leadership

Revenue Cycle Management

Coaching & Development

Healthcare Administration

Communication Skills

Confidentiality

Education

High school diploma or equivalent

Bachelor’s degree in Health Information Administration

3 years medical authorization experience

2+ years leadership experience

CMS guidelines knowledge

Job description

USA Clinics Group in Northbrook, IL is seeking an Insurance and Prior Authorization Manager to lead a team including clinical documentation improvement specialists and clerical staff. The role requires close collaboration with physicians, the SVP of Revenue Cycle, and management to ensure efficient authorization processes.

Key duties include monitoring productivity, coaching staff, managing pre-authorization/eligibility automation, and coordinating with IT and billing on denials and workflow