Dosher Memorial Hospital
Pre-Certification/Prior Authorization Manager - Patient Service Center
Dosher Memorial Hospital, Southport, North Carolina, United States, 28461
Job Posting
Pre-Certification/Prior Authorization Manager - Patient Service Center Full-Time
Position Summary
The manager of pre-certification and prior authorizations oversees the critical process of securing insurance approvals for medical services before patients receive care. This role ensures that patients can access necessary treatments and helps the hospital minimize financial risks related to denials and delays in reimbursement. The Manager leads and manages a team of specialists responsible for obtaining timely and accurate pre-certifications and prior authorizations for hospital services, procedures, and medications. This role is crucial for ensuring patient access to care, minimizing claim denials, and optimizing the hospital's revenue cycle.
Qualifications Education: • Bachelor's degree in Healthcare Administration, Business Administration, or a related field (preferred). A high school diploma or equivalent may be accepted with extensive relevant experience.
Experience: • Minimum of 3-5 years of experience in prior authorization and pre-certification processes, preferably within a hospital or healthcare setting. • Proven experience in a leadership or supervisory role (preferred). • Experience navigating complex insurance policies and procedures, including Medicare Part D (if applicable).
Functions of the Position (not an exhaustive list): • Oversees the entire prior authorization lifecycle, from initial request to approval or denial. • Communicates effectively with insurance companies to expedite approvals and resolve complex cases • Reviews complex cases and assists the team in resolving authorization challenges • Manages and tracks denials and appeals, working with payers to overturn unfavorable decisions • Identifies and addresses trends related to prior authorization outcomes and reimbursement • Manages, trains, and mentors a team of prior authorization specialists • Conducts performance evaluations, provides feedback, and implements disciplinary actions as needed
Additional Information Position Type : Full Time Shift : Day
Contact Information Megan Shrewsbury - HR Manager Human Resources 924 N. Howe St Southport, NC 28461 Email: meganshrewsbury@dosher.org Phone: 910-457-3801 Fax: 910-457-7013
Pre-Certification/Prior Authorization Manager - Patient Service Center Full-Time
Position Summary
The manager of pre-certification and prior authorizations oversees the critical process of securing insurance approvals for medical services before patients receive care. This role ensures that patients can access necessary treatments and helps the hospital minimize financial risks related to denials and delays in reimbursement. The Manager leads and manages a team of specialists responsible for obtaining timely and accurate pre-certifications and prior authorizations for hospital services, procedures, and medications. This role is crucial for ensuring patient access to care, minimizing claim denials, and optimizing the hospital's revenue cycle.
Qualifications Education: • Bachelor's degree in Healthcare Administration, Business Administration, or a related field (preferred). A high school diploma or equivalent may be accepted with extensive relevant experience.
Experience: • Minimum of 3-5 years of experience in prior authorization and pre-certification processes, preferably within a hospital or healthcare setting. • Proven experience in a leadership or supervisory role (preferred). • Experience navigating complex insurance policies and procedures, including Medicare Part D (if applicable).
Functions of the Position (not an exhaustive list): • Oversees the entire prior authorization lifecycle, from initial request to approval or denial. • Communicates effectively with insurance companies to expedite approvals and resolve complex cases • Reviews complex cases and assists the team in resolving authorization challenges • Manages and tracks denials and appeals, working with payers to overturn unfavorable decisions • Identifies and addresses trends related to prior authorization outcomes and reimbursement • Manages, trains, and mentors a team of prior authorization specialists • Conducts performance evaluations, provides feedback, and implements disciplinary actions as needed
Additional Information Position Type : Full Time Shift : Day
Contact Information Megan Shrewsbury - HR Manager Human Resources 924 N. Howe St Southport, NC 28461 Email: meganshrewsbury@dosher.org Phone: 910-457-3801 Fax: 910-457-7013