Precertification Manager

Precertification Manager

About Neurocare

Neurocare, Inc., is the largest employer of Sleep Technologists in the New England area for over 25 years.  We are a patient-centric, quality-focused organization.  We collaborate with high profile academic medical centers, community hospitals, and physician groups to design and manage state of the art sleep disorder programs.  Our strong commitment to uncompromising quality care and customer service has driven our reputation as a leader in the field. 

Position Summary

The Precertification Manager is responsible for the daily oversight, leadership, and performance management of the precertification team. This role oversees workload distribution, staff training and development, quality assurance, productivity monitoring, and process improvement initiatives to ensure efficient and accurate precertification operations. 

The Precertification Manager serves as a key resource for staff, providers, payers, and leadership by maintaining current knowledge of insurance precertification criteria, authorization processes, and industry trends. This position works collaboratively across departments to support optimal patient outcomes, operational efficiency, regulatory compliance, and exceptional customer service.

Under general direction, the Precertification Manager coordinates all aspects of sleep study precertification, including communication with referring providers, educating patients on the authorization process, facilitating alternative testing solutions when services are denied, and supporting transitions to Home Sleep Testing (HST) when clinically appropriate and within payer guidelines.

Essential Leadership Responsibilities

• Provide daily leadership, direction, coaching, and operational support to the precertification team.
• Foster a positive, accountable, team-oriented work environment focused on collaboration, professionalism, and customer service.
• Monitor team productivity, quality, attendance, and performance metrics to ensure departmental goals are consistently achieved.
• Conduct regular staff audits, coaching sessions, and performance reviews to identify opportunities for improvement and professional growth.
• Assist with hiring, onboarding, training, and ongoing education of new and existing staff members.
• Lead by example through professionalism, accountability, communication, and adherence to company standards and policies.
• Escalate operational concerns, staffing challenges, workflow barriers, or performance issues to leadership in a timely manner.
• Support change management initiatives, workflow enhancements, and implementation of operational best practices.
• Facilitate communication between departments to promote operational efficiency and continuity of care.
• Ensure workload distribution is balanced appropriately among team members based on departmental priorities and staffing needs.
• Promote continuous improvement initiatives to enhance productivity, patient satisfaction, and overall department performance.

Trend Identification & Issue Resolution

• Identify operational trends, recurring issues, workflow bottlenecks, and process gaps impacting productivity, quality, or customer service.
• Conduct root cause analysis to determine underlying causes of operational challenges and implement corrective action plans.
• Partner with leadership and cross-functional teams to develop and implement process improvements and operational efficiencies.
• Assist with the development, revision, and maintenance of Standard Operating Procedures (SOPs), workflows, training materials, and best practices.
• Monitor department metrics and audit findings to proactively identify opportunities for improvement and risk reduction.
• Escalate significant operational concerns, trends, or compliance risks to leadership in a timely manner.

Management Responsibilities

• Provide day-to-day support, guidance, and escalation assistance to team members.
• Conduct daily and weekly audits to ensure quality, compliance, accuracy, and performance standards are consistently met.
• Partner with management to review audit findings, identify trends, and perform root cause analysis.
• Identify training opportunities and provide ongoing coaching, mentoring, and staff development.
• Lead weekly team meetings to review operational updates, workflow changes, departmental goals, and performance trends.
• Facilitate real-time team communication to support daily operations and address workflow concerns promptly.
• Oversee workload distribution and ensure efficient task prioritization across team members.
• Communicate daily and weekly priorities while monitoring team productivity, accountability, and overall performance.
• Serve as a resource for staff questions, workflow escalations, and operational troubleshooting.
• Promote a positive, collaborative, and accountable team environment focused on customer service and operational excellence.
• Monitor staff attendance, productivity, and adherence to departmental expectations while addressing performance concerns promptly and professionally.
• Assist leadership with employee evaluations, disciplinary action plans, and performance improvement initiatives as needed.

Essential Functions

Operational Management

• Collaborate with the Associate Corporate Director of Operations to:
  • Establish departmental standards and performance expectations.
  • Monitor employee performance and implement corrective action when necessary.
  • Supervise and direct administrative staff to optimize patient flow and operational efficiency.
  • Coordinate schedules, staffing coverage, and workload distribution, including weekends and holidays as needed.
• Identify, communicate, and monitor departmental goals, outcomes, and key performance indicators.
• Monitor daily workflows to ensure timely processing of precertification's and minimize scheduling delays.
• Develop, implement, and maintain workflows, procedures, and audit processes to support operational accuracy and efficiency.
• Identify opportunities to streamline processes and improve both internal operations and customer experience.

Quality Assurance & Compliance

• Conduct ongoing quality audits to ensure compliance with payer requirements, company standards, and regulatory guidelines.
• Monitor for trends, denials, and process deficiencies while implementing corrective action plans when needed.
• Ensure all required documentation, forms, and authorization information are current and compliant with payer requirements.
• Maintain accurate and detailed documentation within all applicable patient account systems and databases.
• Work collaboratively with billing departments to resolve denials related to precertification issues.
• Maintain a thorough understanding of system reports related to authorization processes, eligibility, and workflow management.

Staff Training & Education

• Train and educate staff on precertification criteria, workflows, insurance requirements, and departmental procedures.
• Provide ongoing education regarding changes in payer requirements, authorization processes, and clinical guidelines.
• Support staff development through coaching, mentorship, and continuous performance feedback.
• Educate providers and physician office staff regarding study types, payer requirements, and authorization processes.

Patient & Provider Coordination

• Coordinate and manage all aspects of sleep study precertification and authorization processing.
• Communicate with patients regarding authorization requirements, denials, alternatives, and next steps.
• Collaborate with physicians to clarify orders, obtain additional clinical documentation, or coordinate alternative testing options.
• Coordinate referrals when specialist referrals are required prior to authorization approval.
• Communicate authorization outcomes to providers, patients, and internal teams in a timely manner.
• Maintain positive working relationships with payers, utilization management representatives, providers, and physician offices.

Insurance Verification & Authorization Management

• Verify insurance coverage and precertification requirements through written and verbal communication with payers.
• Submit and monitor authorization requests while ensuring timely follow-up and resolution.
• Update payers regarding changes in dates of service, CPT codes, or study revisions as required.
• Identify missing or inaccurate patient information and obtain necessary corrections promptly.
• Utilize system resources, portals, and online tools effectively to obtain and verify information.
• Maintain a thorough understanding of payer contracts, authorization requirements, and coverage limitations.

Baseline Productivity Expectations

• Process an average of 30–40 authorization submissions daily.
• Maintain denials related to verification errors at fewer than three annually.
• Maintain precertification errors (wrong study/wrong site) at no greater than one annually.
• Ensure:
  • Post-study authorizations are updated when required.
  • Documentation accurately reflects authorization requirements.
  • Payers requiring precertification are appropriately identified.
  • Insufficient clinical information is escalated to the ordering provider promptly.
• Maintain attendance and reliability standards consistent with departmental expectations.

General Responsibilities

• Comply with all company policies, procedures, and compliance standards.
• Maintain professionalism in conduct, communication, and appearance at all times.
• Demonstrate strong customer service skills with patients, providers, payers, and internal teams.
• Proactively identify operational concerns that may impact quality, service, safety, or financial performance.
• Demonstrate reliability, accountability, and strong follow-through on assignments and responsibilities.
• Maintain confidentiality and protect patient information in accordance with HIPAA regulations.
• Participate in ongoing professional development and continuous learning opportunities.
• Assist with record retention and storage requirements.
• Perform additional duties as assigned.

Requirements

• High school diploma or equivalent.
• Bachelor’s degree preferred.
• Prior medical office, healthcare administration, or insurance authorization experience preferred.
• Knowledge of medical terminology preferred.

Qualifications

• Excellent organizational, communication, and time management skills.
• Strong leadership, coaching, and interpersonal abilities.
• Demonstrated leadership ability with experience managing teams, coaching staff, and driving operational performance.
• Ability to multitask and prioritize effectively in a fast-paced environment.
• Strong customer service and problem-solving skills.
• Proficiency in Microsoft Office and ability to learn new software systems.
• Ability to work independently and collaboratively.
• Strong critical thinking and analytical skills.
• Ability to analyze operational data and make informed decisions to improve workflows, productivity, and quality outcomes.
• High attention to detail and accuracy.

Personal Attributes

• Professional and dependable
• Flexible and adaptable
• Positive and team-oriented
• Proactive and solution-focused
• Strong sense of accountability and ownership
• Energetic and motivated

Physical Demands

Must be able to hear, communicate verbally and in writing in English, and perform repetitive motions including typing and computer work. Close visual acuity is required for computer work, reviewing documentation, and data analysis.

Mental Demands / Independent Judgment

Strong organizational and time management skills required. Ability to work independently, prioritize competing responsibilities, exercise sound judgment, and maintain confidentiality in a fast-paced environment.

Neurocare, Inc. EOE