This leadership position is accountable for overseeing all aspects of the organization's prior authorization team and processes including timely and accurate prior authorization submission and appeal, identifying clinical relevance within each order as it relates to Local Coverage Determination, communicating outcomes timely and effectively, trending, and achieving targeted metrics to optimize outcomes. This leader will also be responsible for overseeing and managing the organization's third-party vendor relating to aspects of the prior authorization process and will monitor and validate adherence to Policies and Procedures.

ESSENTIAL DUTIES:

• Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions
• Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate
• Work across departments to manage the entire process from receipt of patient's clinical records, prior authorization submission, to final determination
• Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization
• Ensure that all metrics are achieved and, develop actionable plans that will quickly and efficiently resolve deficits should those occur
• Provide department orientation and ongoing training for all in/direct reports
• Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains
• Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage
• Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results
• Adhere to Pledge of Confidentiality
  • Information regarding a patient of this company shall not be released to any source outside of this company
    without the signed permission of the patient. Furthermore, information will only be released internally on a needto-
    know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by
    this company unless they are directly involved with the patient's case.

COMPETENCIES:

• Passion: Contagious excitement about the company - sense of urgency. Commitment to continuous improvement.
• Integrity: Commitment, accountability, and dedication to the highest ethical standards.
• Collaboration/Teamwork: Inclusion of Team Member regardless of geography, position, and product or service.
• Action/Results: High energy, decisive planning, timely execution.
• Innovation: Generation of new ideas from original thinking.
• Customer Focus: Exceed customer expectations, quality of products, services, and experience always present of mind.
• Emotional Intelligence: Recognizes, understands, manages one's own emotions and is able to influence others. A critical skill for pressure situations.

QUALIFICATIONS:

• Bachelor's degree
• 3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management
• Strong understanding of clinical review and prior authorization management
• Proven record of achieving aggressive metrics and outcomes

Preferred:

• Bachelor's degree
• 10+ years of leading revenue cycle management functions
  Experience in vendor management or offshore staff augmentation relationships

SUPERVISORY RESPONSIBILITES:

• Directly manage Prior Authorization team members including but not limited to conducting performance reviews, providing feedback, and helping to set professional development goals.

WORK ENVIRONMENT:

• Remote, yet fast-paced work environment
• Extended hours when needed
• Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug Administration and under contract with Medicare. Kestra maintains a drug free workplace and testing is a condition of employment.

PHYISCAL DEMANDS:

• Frequent repetitive motions that may include wrists, hands and/or fingers, such as keyboard and mouse usage
• Frequent stationary position, often sitting for prolonged periods of time
• Occasional bending and stooping
• Occasional lifting up to 20 pounds

TRAVEL:

• Occasional travel, less than 10%

OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the Team Member. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

BENEFITS:

Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc.

Pay equity is an important part of Kestra's Culture. Our compensation ranges are guided by national and local salary surveys and take into consideration experience level and internal equity. Each role is benchmarked based on the job description provided If your qualifications and/or experience level are outside of the posted position, we encourage you to apply as we are growing fast and roles that are coming soon may not be posted.

Salary: Annualized at $100,000 - $120,000 plus bonus. Depending on experience.