Manager, Prior Authorization

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Responsible for overseeing the prior authorization and referral teams who authorize services in accordance with company policies and procedures.

Essential Functions
-Leads the prior authorization and referral team, including hiring, training, and evaluating staff performance.
-Oversees insurance verification, authorization, and referral procurement/verification processes to ensure timely and accurate patient information.
-Implements and monitors policies and procedures to maintain compliance with regulatory and payer requirements, including authoring departmental standard-of-work documents.
-Collaborates with clinical and administrative teams to resolve prior authorization issues that impact patient care or billing.
-Analyzes authorization metrics to identify trends and opportunities for process improvements.
-Mentors and develops team members through annual performance reviews, scheduled touch bases, and goal planning.
-Develops and delivers training programs to enhance staff knowledge of insurance guidelines and authorization requirements.

Qualifications

Education
Bachelor's Degree Healthcare Administration required or Bachelor's Degree Business Administration required or Bachelor's Degree Related Field of Study required

Can this role accept experience in lieu of a degree?
Yes

Experience
Experience in revenue cycle operations or financial clearance 5-7 years required and Experience in a management role 2-3 years required and Epic experience 2-3 years preferred

Knowledge, Skills and Abilities
- Strong knowledge of insurance verification, billing practices, and healthcare regulations.
- Strong leadership and team management abilities.
- Proficiency in revenue cycle management and financial clearance processes.
- Excellent analytical skills to assess and improve operational performance.
- Exceptional communication and interpersonal skills for engaging with staff and patients.
- Ability to manage multiple priorities and work in a fast-paced healthcare environment.
- Attention to detail and a commitment to accuracy in financial processes.

Additional Job Details (if applicable)

• M-F Eastern Business hours required for remote role

•A quiet, secure, stable, HIPPA-compliant workstation is required.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$79,560.00 - $115,720.80/Annual

Grade

7At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.