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Manager, Enterprise Authorization Services
WVU Medicine. Coordinate and control activities related to insurance prior authorization .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare accounts receivables management, including billing and collections, while effectively leading and training a team of authorization specialists. Proficient in analyzing denial metrics and implementing process improvements to enhance authorization workflows and compliance with regulatory requirements.
Highest-signal resume keywords
Healthcare Accounts Receivables ManagementSupervisory ExperienceKnowledge of Medicare and Medicaid RegulationsDenial Management and ReductionProcess Improvement Initiatives
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Billing and CollectionsAuthorization WorkflowsData AnalysisMedical TerminologyCPT CodingICD9/10 CodingDRGsUtilization ManagementInterQual CriteriaUB-04 Knowledge
Soft Skills
Effective Organizational SkillsAttention to DetailInitiativeFollow-Through
Tools & Technologies
EPIC System
Certifications & Qualifications
Certified Healthcare Financial Professional (CHFP)
Industry Keywords
Insurance Prior AuthorizationRevenue Cycle ManagementPatient Billing OperationsGrievance ProceduresManaged Care
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Full-time schedule of 40 hours per week
- Exempt status