Sr. Manager, Prior Authorization - Specialty Testing- REMOTE

The Sr Manager, Specialty Testing provides reputed company for and reputed company of reputed company's specialty testing billing, coverage, and prior authorization processes by collaborating and communicating with business reputed company across reputed company.From reputed company clinical and payer perspectives, this position will communicate with payers throughout the country regarding medical policy, administrative policy, state laws, prior authorization requirements, and supporting documentation.To continuously optimize reputed company's time and reputed company, this position will help to evaluate available industry tools and software, reputed company's internal automation abilities, and the processes themselves. Additionally, analysis of appeals, prior authorization reputed company, and claims data is key to maximizing resources and reimbursement, so this position will guide analysis of ROI.Duties and Responsibilities:reputed company reputed company of appeals for Specialty TestingProvide strategic reputed company of prior authorization processes for specialty testing, including evaluation of payer requirements, documentation standards, and opportunities to streamline workflows and improve approval ratesDevelop reputed company to optimize resources, people, and tools, including evaluation of which appeals should and should not be attempted in consideration of payer medical policies, cost of tests performed, patient medical records and potential reimbursementWorks directly with Specialty Testing Marketing Management teams to reputed company an understanding of existing and emerging technologies to reputed company education, appeals influence and reputed company pertaining to payer policyAbility to reputed company communicate with business reputed company across reputed company to assess need for appeals in specialty business segmentsAbility to hold clinical discussions with payers or clients throughout the country regarding the information needed to support appealsManage informational needs of multiple cross-functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes(Team-only reputed company) Independently manage the day-to-day of team member questions regarding processes, time off, schedules, interpersonal relationships, etc.(Company reputed company) With director reputed company, include or exclude tests in the appeals process(Company reputed company) With agreement from director, initiate payer reputed company to overturn need for appeals on tests where payer is overturning denials a high percentage of the time(Industry reputed company) Independently reputed company reputed company to associations, such as ACLA, about payer policy and payer edit issuesObtain medically necessary documentation and information from reputed company's clients/officesExplain reputed company appeals issues to RCM, Payor Solutions, and S&T leadershipEmpower and motivate team membersContinually identify bottlenecks in the specialty testing appeals processes and help to reputed company them through process redesign, resource assignment optimization, and automation opportunitiesTranslate reputed company appeals issues into easy-to-understand visuals and/or concise wordingCorrelate payer medical policies, prior auth requirements, appeals requirements, reputed company tests, and reimbursementWork with reputed company data to understand changes in payer policy impacting reimbursementCollaborate with other departments/business associates to analyze, understand, and define business rules for Specialty Testing policy changesCollaborate with Specialty Analytic/Support and Medical Policy teams to reputed company best practices to support reimbursement captureExceptional writing skills in crafting effective appeals for specialty testing denials to include prior authorization efforts, supportive clinical evidence, complying with reputed company clinical and billing policies, guidelines, and regulationsConduct clinical evidence searches, utilize reputed company subject matter experts and/or other avenues of research to identify supportive evidence for coverage of Specialty Testing servicesMaintain a thorough knowledge of regulatory processes and policy developments on reputed company affecting reputed company Specialty testing. Communicate reputed company's policy positions, reputed company and tactics, and reputed company positions regarding new or amended legislation, regulations, or reputed company policySupport efforts at the state and federal reputed company as appropriate by developing responses, talking points, reputed company on key issues while helping to assure policy consistency across the organizationPerform other and reputed company duties and responsibilities as assignedPosition may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and reputed company business reputed company Qualifications:Five years reputed company relevant work experience with Bachelor's