Manager, Prior Authorization and Referrals Healthcare At Home

Mass General Brigham; Somerville (MA); Remote; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking organization dedicated to advancing healthcare through exceptional patient care and innovative practices. As a Manager in Prior Authorization and Referrals, you will lead a dynamic team focused on optimizing processes and enhancing patient experiences. This role involves collaborating with key stakeholders to ensure efficient operations while driving improvements in technology and workflow. Your leadership will be pivotal in fostering a high-performing team that contributes to groundbreaking medical discoveries. Experience the impact of your work in a supportive environment that values your contributions and professional growth.

Qualifications

• 2+ years of healthcare experience required.
• Strong skills in managing teams and processes.

Responsibilities

• Oversee daily operations of prior authorization and referrals team.
• Ensure smooth patient experience and minimize revenue leakage.

Skills

Leadership in complex organizations

Operational management

Process optimization

Communication skills

Customer service

Knowledge of health insurance practices

Consensus building

Education

Bachelor's degree in Healthcare Administration

Bachelor's degree in Business Administration

Tools

Epic

Workforce management technologies

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

Provides leadership and efficient oversight of day-to-day activities and teams in the prior authorization and referrals space. In partnership with key stakeholders, the Manager, Prior Authorization and Referrals, contributes to and supports enterprise prior authorization and referral strategy, continuously working to improve people, process, and technology across the function. The Manager provides leadership and direct supervisory support of team members.

The prior authorization and referrals team is responsible for insurance validation & verification, capture of insurance referrals and prior authorizations, updating patient data in Epic, and work queue management functions. Through their leadership and oversight, the Manager, Prior Authorization and Referrals will ensure patients receive a smooth and efficient experience while collecting accurate insurance and related information, facilitating administrative procedures for clean claims with complete data. They will also incorporate denial prevention and payer requirements into workflow to minimize revenue leakage. For the Healthcare At Home division, this role works closely with the Patient Financial Services team on denial appeals and write-off decisions.

Qualifications

Education

• Bachelor's degree preferred in Healthcare Administration, Management, Finance, Business Administration, or related field.

Work Experience

• Minimum of 2 years relevant healthcare experience, including registration and/or managed care referral experience.

Skills/Abilities/Competencies

• Demonstrates leadership in a large, complex organization with multiple locations.
• Strong operational management and process/technology optimization skills.
• Excellent personnel and organizational management skills, including communication, relationship management, customer service, and organization.
• Knowledge of patient registration contractual terms, health insurance practices, and industry standards.
• Familiarity with call center technologies such as workforce management, ACD routing, and quality monitoring.
• Effective communication within and between system functions.
• Enterprise-wide perspective and risk management.
• Ability to build consensus and lead change within a matrix organization.
• Judgment in handling sensitive, confidential information.

Leadership Impact & Problem Solving

• Develops and retains front-line team members.
• Oversees recruiting, hiring, and onboarding.
• Acts as a role model aligned with organizational values.
• Empowers team members for front-line decision-making.
• Sets high standards of professionalism and integrity.
• Supports professional development.
• Aligns deployment with enterprise strategy, standardizing processes.
• Drives focus and efficiency across teams.
• Identifies and mitigates risks such as denials and delays.

Monitors team performance, provides feedback, and ensures policy adherence. Completes performance appraisals and sets development goals. Analyzes operational problems, recommends solutions, and embraces change.

Financial and Operational Performance

• Assists in budget development and cost-effective service delivery.
• Monitors productivity, manages queues, and minimizes denials and errors.
• Analyzes trends and resolves operational issues.
• Supports development of standard processes and technology improvements.

Key Interactions

• Patient Access and Experience Team
• Health Care at Home leadership
• Ambulatory and Hospital Operations Management
• Payer Services Team
• Denials Prevention Team

Decision Rights

Accountable: Ensuring productivity, efficiency, and accuracy.

Responsible: Monitoring KPIs, prioritizing resources, managing daily operations.

Consulted: Defining goals, policies, and budgets.

Informed: Developing enterprise revenue cycle strategy.

Other duties as assigned.

Additional Job Details

Remote Type: Remote

Work Location: 399 Revolution Drive

Scheduled Weekly Hours: 40

Employee Type: Regular

Work Shift: Day (United States of America)

EEO Statement

Mass General Brigham is an Equal Opportunity Employer. We consider all qualified applicants without regard to race, color, religion, sex, age, gender identity, disability, sexual orientation, military service, genetic information, or other protected status. We provide reasonable accommodations for individuals with disabilities during the application process and employment.