Authorization Manager

Description

Prompt Care is seeking a highly motivated and experienced Initial Authorization Manager to join our team. The ideal candidate will have a strong background in healthcare, particularly healthcare insurance guidelines along with strong team management skills. The position will entail the management of the Initial Authorization staff documentation compliance and payer related issues impacting the ability to obtain Initial Authorizations. The manager will work collectively with Intake and Resupply management and staff to ensure authorization requirements are fulfilled.

Job Type: Full-time, Exempt

Location: Hybrid 2 days per week based out of King of Prussia, PA

• Bachelor’s degree preferred or comparable equivalent and related experience
• Previous experience in DME is required
• Medical reimbursement knowledge is required
• Prior experience managing or overseeing staff is required
• Appropriate computer skills for the position (Microsoft Office Suite) and areas of influence;
  Brightree experience is required
• Strong work ethic and the desire to lead by example, with attention to detail and quality
• Ability to deal directly with staff on policy or performance-related issues
• Excellent oral and written communication skills required to communicate with colleagues, management, customers, and insurance plan representatives

• Ensure all initial tasks are worked and completed timely, ensuring accuracy with payer requirements including procedure codes, diagnosis, quantity limitation, initial start dates and required documentation.
• Suggest, implement and update any changes in policy, fee schedule and other payer limitations via Brightree or internal process according to existing payer guidelines.
• Stay current on payer policy updates along with coverage criteria.
• Ensure all payer portals are accessible to staff. Remain proficient in portal use within the team.
• Provide regular reporting to Senior Management by monitoring productivity and metric measurement along with other KPI’s as needed. Communicate regular feedback to staff on process, compliance and other related performance measurements.
• Identify recurring denial patterns and implement corrective action alongside appeals process to reduce bad debt.
• Be an active participant in education and development of staff.

The physical requirements outlined here are indicative of what an employee must meet to effectively carry out the essential functions of this role. While performing job duties, the employee is frequently required to communicate verbally and listen attentively. The role necessitates the ability to lift files, open filing cabinets, and bend or stand as needed. Additionally, the position occasionally requires lifting office products and supplies weighing between 20 and 30 pounds.

• Comprehensive Medical, Dental, and Vision Package
• 401(k) Plan with Company Match
• Generous PTO:
  Vacation, Sick Time, Personal Days, and Paid Holidays
• Life Insurance:
  Standard coverage with optional enhancements
• Employee Assistance Program:
  Free counseling and coaching sessions
• Emotional Well-being and Work-Life Balance Resources
• Short & Long-Term Disability:
  Company-paid with optional supplements
• Accidental Death and Dismemberment Insurance
• FSA and HSA:
  Manage healthcare expenses
• Commuter Spending Programs
• Volunteer and Engagement Opportunities
• Employee Referral Bonuses
• Exclusive Discounts on entertainment, travel and various other supplemental and cellphone plans

The Prompt Care Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.