US:NV:Carson City Authorization
Full Time Day Shift
Summary
Responsible for the management of the system's authorization and financial clearance functions to ensure timely access to care, reimbursement readiness, regulatory compliance, and optimal reimbursement. This role provides leadership for authorization and financial clearance staff, develops standardized workflows, monitors performance metrics, and collaborates with clinical, operational, patient access, and revenue cycle teams to reduce authorization-related denials, improve financial clearance processes, and enhance the patient experience. The Manager partners closely with internal departments and external payers to support financial performance, operational excellence, and a seamless pre-service experience. Serves as a change agent in a constantly changing and growing system and drives process improvements and system enhancements that support organizational growth and revenue cycle performance.
Qualifications
Required:- Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, or a related field, or equivalent relevant experience
- Minimum of five (5) years of experience in healthcare patient access, referrals, authorizations, revenue cycle, managed care, or related healthcare operations
- Minimum of two (3) years of leadership, supervisory or management experience
- Strong knowledge of referral management, prior authorization requirements, payer guidelines, reimbursement methodologies, and healthcare revenue cycle operations
- Working knowledge of Medicare, Medicaid, commercial payer requirements, regulatory standards, and accreditation requirements impacting referrals and authorizations
- Experience analyzing operational and financial data and implementing process improvement initiatives
- Proficiency with electronic health records, authorization management systems, reporting tools, and data analytics
- Demonstrated ability to lead teams, manage change, and drive operational performance in a complex healthcare environment
Preferred:- Master's degree in Healthcare Administration, Business Administration, Healthcare Management, Public Health, or a related field
- Seven (7) or more years of experience in healthcare patient access, referrals, authorizations, revenue cycle, or related healthcare operations
- Three (3) or more years of management experience
- Experience leading multi-site or multi-specialty referral and authorization operations
- Experience managing authorization-related denials, denial prevention strategies, and payer escalation processes
- Certification in healthcare management, patient access, revenue cycle, managed care, or a related field
- Experience in a multi-specialty physician practice, hospital, or integrated health system environment
- Experience with Epic, referral management platforms, contract management systems, and business intelligence reporting tools
Essential Functions
- Provides leadership and strategic direction for referral and authorization operations across the organization.
- Develops departmental goals, key performance indicators, productivity standards, and quality metrics aligned with organizational objectives.
- Oversees referral and authorization workflows to ensure timely patient access, regulatory compliance, and reimbursement optimization.
- Provides leadership and oversight of financial clearance activities, including insurance eligibility and benefits verification, prior authorization, and pre-service financial clearance processes to ensure patients are financially cleared prior to service, reduce reimbursement risk, and support an exceptional patient experience.
- Monitors departmental performance, denial trends, authorization turnaround times, payer requirements, and operational outcomes; implements corrective actions as needed.
- Leads denial prevention initiatives related to referrals, prior authorizations, medical necessity, and payer requirements.
- Collaborates with physician practices, patient access, revenue cycle, scheduling, utilization management, and clinical leadership to improve operational effectiveness and patient experience.
- Develops and maintains department policies, procedures, standard work, and compliance programs.
- Analyzes operational, financial, and performance data to identify opportunities for process improvement, resource allocation, and workflow optimization.
- Oversees staffing plans, recruitment, onboarding, employee development, succession planning, and performance management activities.
- Serves as a resource and escalation point for complex payer issues, referral challenges, authorization denials, and regulatory concerns.
- Partners with payer representatives and organizational leaders to address operational issues, implement process improvements, and ensure compliance with contractual requirements.
- Supports organizational audits, accreditation activities, regulatory reviews, and compliance initiatives.
- Prepares and presents departmental reports, performance metrics, and recommendations to senior leadership.
- Leads and supports organizational projects related to patient access, revenue cycle optimization, technology implementation, and operational excellence.
- Performs other related duties as assigned.
