Manager, Prior Authorization

0100 Mass General Brigham Incorporated; Somerville (MA); Remote; USD 80,000 - 116,000; Full time

Job summary

Mass General Brigham is seeking a dedicated leader to oversee the prior authorization and referral teams, ensuring compliant, efficient workflows across the revenue cycle.

The role emphasizes staff hiring, training, and performance coaching, close collaboration with clinical teams, and ongoing process improvements to support timely patient care.

Qualifications

• Strong knowledge of insurance verification, billing practices, and healthcare regulations.
• Excellent leadership and team management abilities.
• Experience with revenue cycle management and financial clearance processes.
• Excellent analytical and communication skills.
• Ability to manage multiple priorities in a fast-paced healthcare environment.

Responsibilities

• Leads the prior authorization and referral team, including hiring, training, and evaluating staff.
• Oversees verification, authorization, and referral procurement to ensure timely patient data.
• Implements policies to stay compliant with regulatory and payer requirements.
• Collaborates with clinical and administrative teams to resolve authorization issues.
• Analyzes authorization metrics to identify trends and improvement opportunities.
• Mentors staff through performance reviews and goal setting.
• Develops and delivers training on insurance guidelines and authorization requirements.

Skills

Insurance verification

Billing practices

Healthcare regulations

Leadership

Communication

Education

Bachelor's degree in Healthcare Administration

Tools

Epic

Job description

Site:

Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Responsible for overseeing the prior authorization and referral teams who authorize services in accordance with company policies and procedures.

Essential Functions

• -Leads the prior authorization and referral team, including hiring, training, and evaluating staff performance.
• -Oversees insurance verification, authorization, and referral procurement/verification processes to ensure timely and accurate patient information.
• -Implements and monitors policies and procedures to maintain compliance with regulatory and payer requirements, including authoring departmental standard-of-work documents.
• -Collaborates with clinical and administrative teams to resolve prior authorization issues that impact patient care or billing.
• -Analyzes authorization metrics to identify trends and opportunities for process improvements.
• -Mentors and develops team members through annual performance reviews, scheduled touch bases, and goal planning.
• -Develops and delivers training programs to enhance staff knowledge of insurance guidelines and authorization requirements.

Qualifications

Education Bachelor's Degree Healthcare Administration required or Bachelor's Degree Business Administration required or Bachelor's Degree Related Field of Study required Can this role accept experience in lieu of a degree? Yes Experience Experience in revenue cycle operations or financial clearance 5-7 years required and Experience in a management role 2-3 years required and Epic experience 2-3 years preferred Knowledge, Skills and Abilities

• - Strong knowledge of insurance verification, billing practices, and healthcare regulations.
• - Strong leadership and team management abilities.
• - Proficiency in revenue cycle management and financial clearance processes.
• - Excellent analytical skills to assess and improve operational performance.
• - Exceptional communication and interpersonal skills for engaging with staff and patients.
• - Ability to manage multiple priorities and work in a fast-paced healthcare environment.
• - Attention to detail and a commitment to accuracy in financial processes.

Additional Job Details (if applicable)

M-F Eastern Business hours required for remote role A quiet, secure, stable, HIPPA-compliant workstation is required. Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $79,560.00 - $115,720.80/Annual Grade 7

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package.

In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Combat disease. Hold a hand. Help people. Impact the world. Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives.

Are you ready? Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.