The Authorization Manager provides leadership and operational oversight for the authorization team and serves as a key liaison between the Business Office, clinic leadership, physicians, and authorization staff. This role is responsible for ensuring efficient workflows, timely authorization processing, and high-quality service delivery. The manager drives team performance, staff development, and accountability for quality and productivity metrics, while leading workflow optimization and system improvements. This position also oversees escalations, payer communications, denial management, and compliance with insurance, regulatory, and documentation requirements.
Responsibilities:- Foster an environment that reinforces Rebound's mission and Core Values of Superior Service, Teamwork, Integrity, Innovation, Quality and Recognition.
- Provide leadership to ensur consistent, high-quality service across the organization.
- Recruit, hire, onboard and supervise authorization staff.
- Direct and oversee the daily operations of the Authorizations team to optimize department function and maximize productivity.
- Provide ongoing training and development to authorizations team. Establish performance standards, conduct evaluations, coaching and development plans to drive individual and team success.
- Troubleshoot, manage and respond to escalations or patient issues as they relate to authorizations.
- Communicate, consult, and collaborate cross-functionally to resolve workflow challenges, improve denial management, and other authorization related issues.
- Oversee verification of insurance eligibility, benefits, coverage limitations and prior authorization requirements.
- Ensure timely and accurate submission, tracking, and completion of authorizations within required service timelines.
- Maintain accountability for the accuracy and completeness of authorization requests, including review of clinical documentation against payer medical necessity criteria.
- Monitor authorization status and direct follow-up activities to secure timely approvals and minimize delays in care and revenue cycle processes.
- Prioritize incoming prior authorization requests according to need and urgency. Seek retro authorizations when necessary or requested by Business Office.
- Lead denial management efforts, including escalation, appeal coordination, and collaboration with providers for peer-to-peer reviews.
- Ensure clear and effective communication of authorization determinations, requirements, and delays with providers, staff, and patients.
- Maintain expertise in payer policies, authorization requirements, and applicable state and federal regulations.
- Monitor and ensure achievement of departmental performance metrics related to productivity, quality, and customer service.
- Maintain a high degree of confidentiality and abide by all HIPAA rules and regulations.
- Perform other duties as assigned.
Qualifications:- High School Graduation or GED. Bachelor's degree preferred, equivalent expertise is considered in lieu of educational requirements.
- Minimum of 5 years' experience working with authorization or health insurances, or related experience.
- 2-3 years previous supervisory experience required.
- Knowledge of health insurance, insurance portals and processes.
- Knowledge of medical office procedures.
- Ability to maintain confidentiality of sensitive information.
- Ability to process patient and public inquiries and respond with poise and efficiency.
- Ability to recognize, evaluate and solve problems, and correct errors.
- Must have excellent communication, organizational, and follow up skills with attention to detail.
- Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
- Working knowledge of industry standards and insurance contracts.
Physical Requirements: - Work may require sitting for long periods of time.
- Requires manual dexterity sufficient to operate a keyboard, operate telephone, headset, copier and computer software.
- Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts.
- It is necessary to view and type on computer screens for long periods and to work in an environment which can be fast-paced and constantly interrupted.
- Work is performed in a small office environment.
- Involves frequent telephone contact with patients, insurance, companies and providers.
- Tasks are of minimal hazardous conditions.
Proud to Offer:- Medical/Vision/Rx
- Dental
- 401(K) Retirement Plan, including discretionary profit sharing and Cash Balance Plan
- Company paid Life Insurance/AD&D
- Voluntary Life insurance/AD&D
- Company paid short and long-term disability
- Flexible Spending and Health Saving Accounts
- Employee Assistance Program
- Free Parking
- Paid Time Off accrued at up to 24 days in your first year based on FTE
Monday-Friday, no weekends or holidays.
This is a full-time, 40 hour per week position.
