Insurance & Prior Authorization Manager — Revenue Cycle Leader

USA CLINIC SL; 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 in Northbrook, IL seeks an Insurance and Prior Authorization Manager to join our growing team. You will collaborate with physicians, the SVP of Revenue Cycle, and management to oversee and optimize prior authorization processes.

You will supervise clinical documentation improvement specialists and administrative staff, ensure CMS and payer guidelines are followed, and drive performance reporting and automation initiatives.

Qualifications

• 3 years medical authorization experience required.
• 2+ years in a leadership role required.
• Active knowledge of CMS guidelines contracted insurance guidelines and coding policies.
• Excellent verbal and written communication skills.
• Detail oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
• Bachelor’s degree in health information administration preferred; high school diploma required.

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.

Skills

Leadership

Communication

Attention to detail

Confidentiality

Multi-tasking

CMS guidelines

Education

High school diploma or equivalent

Bachelor’s degree in health information administration

Job description

USA Clinics Group in Northbrook, IL seeks an Insurance and Prior Authorization Manager to join our growing team. You will collaborate with physicians, the SVP of Revenue Cycle, and management to oversee and optimize prior authorization processes.

You will supervise clinical documentation improvement specialists and administrative staff, ensure CMS and payer guidelines are followed, and drive performance reporting and automation initiatives.