Program Manager - Prior Authorizations

Yesterday

🇺🇸 United States – Remote

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $94.9k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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Natera

WebsiteLinkedInAll Job Openings

Non-Invasive Prenatal Testing (NIPT) • Single gene diseases • Preimplantation Genetic Screening (PGS)/Diagnosis (PGD) • Biopsy training • Multi-Disease Carrier Screening

1001 - 5000 employees

Founded 2004

🧬 Biotechnology

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Description

• The Program Manager, Prior Authorizations effectively leads a subset of the Prior Authorization functional area. • Manages the activities of staff through daily supervision while overseeing designated functional area across revenue cycle. • Assists with implementing strategic goals by deploying internal and external staff. • Track/monitor all cases requiring true prior authorization. • Create/provide weekly updates to leadership on all pending/processed cases. • Participate in submission, follow up, and performing necessary action on adverse decisions of prior authorization requests. • Provide strong, timely financial and business analytics for decisions by organizational stakeholders. • Develop actionable roadmaps for improving workflows and processes. • Performs in-depth reviews/audits to identify issues/trends and create remediation plan(s). • Support management of projects to ensure successful and timely completion. • Support management in monitoring and tracking adherence of SOPs, SLA, productivity and quality standards set by leadership. • Evaluate key performance indicators, provide ongoing reports, and recommend business plan updates. • Performs a wide range of analytics functions in a fast-paced team environment using tools such as Excel, Power BI and other business intelligence tools. • Analyzes payer and product prior authorization, denial, and reimbursement trends. • Designs and executes improvement projects. • Conducts complex data analysis and data interpretation. • Meets established deadlines timely, accurately, and with a sense of urgency. • Supervise team including monitoring production and quality to specified goals. • Assists with feedback for hiring, discipline and performance evaluations. • Oversees the process of providing coverage in a production environment. • Provides department orientation for all direct reports and coordinates training per job description. • Ensures that ongoing training is provided for established employees. • Liaisons with internal departments to promote ongoing communication and ensure accuracy. • Acts as an escalated level of response for concerns and complaints. • Assists staff with enforcing policy. • Works with cross functional teams to manage the entire process from insurance verification to final collection of prior authorization. • Monitors and validates adherence to policies and procedures, auditing as necessary. • Completes projects and reports in a timely fashion on a daily, weekly or monthly basis.

Requirements

• Bachelor’s degree or equivalent years of experience. • Minimum of 3 years of experience in supporting a high volume, fast growing billing office within the laboratory setting is preferred. • Bi-lingual (fluent in Spanish) preferred. • Minimum 5 years of experience with prior authorization submission and revenue cycle management software. • Thorough knowledge of healthcare reimbursement (government and private payers) including coverage, coding and payment and understanding of insurance billing practices. • Demonstrated ability to develop and analyze payments, diagnose issues, and present findings to management. • Strong organizational skills; attention to detail. • Ability to proficiently use a computer and standard office equipment. • Working knowledge of Microsoft Office. • Previous experience with Google Enterprise Suite – Gmail, Slides, Sheets, Docs, Drive. • Conflict resolution skills. Must be able to resolve employee issues effectively and efficiently.

Benefits

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. • Free testing and fertility care benefits for employees and immediate families. • Pregnancy and baby bonding leave. • 401k benefits. • Commuter benefits. • Generous employee referral program.