Manager, Enterprise Authorization Services

🕒 October 5

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Coordinate and control activities related to insurance prior authorization • Research and analyze denied services to create and implement workflows that minimize payment denials • Manage, lead, train, develop, direct, and evaluate a team of authorization specialists • Communicate revenue risks to Departmental Directors and Clinic Administrators • Review authorization productivity and timeliness; develop and implement action plans • Monitor staffing levels and reassign work according to organizational priorities • Audit authorization staff work for quality, productivity, and timely authorization and treatment-plan submission • Monitor insurance authorization and reimbursement data trends and report findings to the Director • Identify, implement, monitor, and revise process-improvement initiatives • Propose technology improvements to enhance performance and productivity • Maintain knowledge of payor authorization requirements and state/federal coverage regulations • Oversee pre-certification workflows for assigned services • Analyze denial-management metrics and lead denial-reduction initiatives • Collaborate with hospital billing, professional billing, Outpatient Registration, and Revenue Cycle teams to resolve complex denials and authorization barriers • Manage assigned hospital functions, facilitate timely review, and support front-end peer-to-peer appeals • Represent pre-authorization services in relevant internal and external meetings • Analyze new services for pre-authorization and denial-reduction guidance

🎯 Requirements

• High School Diploma or Equivalent • Five (5) years’ experience healthcare accounts receivables management, billing and collections • Two (2) years of supervisory experience • Knowledge of computers and use/manipulation/application of data for administrative functions • Knowledge of Medicare, Medicaid and other regulatory requirements • Knowledge of UB-04, itemized bills, insurance plans, grievance procedures and utilization management processes • Knowledge of managed care, inpatient and outpatient care, utilization management, and InterQual criteria • Knowledge of patient billing operations • Knowledge of medical terminology and ability to interpret medical-record information • Knowledge of CPT, ICD9/10, and DRGs • Previous experience in an administrative or supervisory role • Effective organizational skills, attention to detail, initiative, and follow-through • Preferred: Bachelor’s degree in Finance, Business Administration or related field • Preferred: Certified Healthcare Financial Professional (CHFP) with HFMA • Preferred: Knowledge of EPIC system

🏖️ Benefits

• Full-time schedule of 40 hours per week • Exempt status