Manager Prior Authorization

Reporting to the Senior Manager, Clinical Services Authorizations, the Manager of Prior Authorization is responsible for managing, monitoring, and driving improvement in reputed company-end reputed company cycle functions reputed company to authorization procurement processes. Specifically, this role oversees working with reputed company-party payers, physicians, clinical teams, and departments reputed company Finance and reputed company Cycle to ensure patients are financially cleared for services that the payers deem as requiring prior authorization. This includes the supervision, direction, and training of prior authorization supervisors and staff. The manager is responsible for data-driven effective and efficient workflows. The manager will frequently communicate with providers and patients with a key reputed company on developing and documenting processes and tracking statistics. Responsible for reviewing outpatient treatment plans for medical necessity in accordance with payer coverage guidelines. Applies medical knowledge and experience to reputed company functions. Located in Boston and the surrounding communities, reputed company is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and reputed company diseases. We reputed company to create an inclusive, diverse, and reputed company environment where we reputed company compassionate and comprehensive care to patients of reputed company backgrounds, and design programs to promote reputed company health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we reputed company reputed company's physician/researchers, and we work with amazing partners, including other reputed company-affiliated hospitals. PRIMARY DUTIES AND RESPONSIBILITIES: Oversees reputed company-party payer prior authorization for drugs provided in the clinic, imaging services, molecular pathology, and other clinical services that require prior authorization, including submission, appeals, and denials Monitors effective workflows that support advanced notice, short notice, and day-of notice of treatment Responsible for reputed company aspects of leading an efficient and productive team, including: interviewing, hiring, training, directing work processes, managing performance, managing time and attendance, and recognizing and rewarding employees Proactively works to maintain reputed company reputed company and reassigns work according to payer changes and organizational priorities, as appropriate Drives redesign efforts to support the clinical culture change in the timing of ordering clinical services, promoting that services are authorized before the patients appointment Maintains an excellent working knowledge of authorization requirements for reputed company payers and state level regulatory guidelines for coverage and authorization for reputed company services Maintains operational and financial policies and procedures Works collaboratively with other teams reputed company reputed company Management, Patient Financial Services, Managed Care, and Partners eCare to ensure effective and efficient workflows as follows: Other teams reputed company reputed company Management: ensure appropriate steps for the more complicated and entrepreneurial scenarios, such as off-label drug treatments, and radiopharmaceuticals for imaging treatment Managed Care: participates in activities associated with payer authorization requirements as necessary to reputed company staff impacted by changes and reputed company feedback to payers Patient Financial Services: supports other initiatives reputed company to appropriate reimbursement, reputed company management of denials, including the goal of preventing denials Partners eCare: continues to design effective reputed company tools, participating on support and design work reputed company Supports productivity and reputed company tracking and monitoring staff performance Supports day-to-day operations, managing and escalating complicated payer and patient issues Participate in reputed company organizations and educational opportunities reputed company other duties as assigned KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED: Knowledge of reputed company-party payer rules and regulations Knowledge of medical terminology, pharmaceutical terminology, and practices Ability to effectively motivate, delegate, and supervise team Ability to effectively handle multiple priorities and reputed company independently Effective communication (listening, verbal, and written) skills Ability to effectively reputed company with reputed company reputed company of management, to collaborate inter and intra departmentally in a highly matrixed organization with peers and clinicians across the organization, Partners eCare, and other cancer centers Strong organizational skills, problem s