Authorization Manager

Position Summary

Facilitate payment authorization from third party payers for RxFunction products. Provide effective education to payers regarding unique features and benefits of RxFunction products for appropriate patient candidates. Build and manage reimbursement team and systems to process orders timely. Deliver exceptional customer service through leadership and by providing a productive work environment to department staff. Oversee a high level of attention to customer accounts, processing customer orders, and communication regarding customer orders with sales team, internal operations, and senior management.

Job Responsibilities

• Coordinate recruiting and development of department staff
• Oversee and assist with intake and entry of orders
• Analyze payer policies and coverage and train department staff accordingly
• Manage patient eligibility and benefits and ensure they are documented in patient accounts
• Confirm required documentation is obtained and uploaded for prior authorization and billing prior to shipment
• Establish process for completion of prior authorizations as required by third party payers
• Administer submission of prior authorization appeals and ensure timely follow-up with payer appeals
• Manage department standards, processes, and improvement activities
• Ensure company policies and procedures, HIPAA compliance, and Medicare guidelines are followed by department staff
• Work closely with sales staff for processing patient orders and obtaining medical documentation
• Interface with Operations and Billing Departments to ensure smooth product transfers and timely claims submission
• Collaborate closely with senior management and other departments on payer relations, coverage policy design and implementation, and other payer related activities
• Provide reports identifying payer trends and other key metrics to senior management

Required Qualifications

• Associate’s degree or higher
• 10 years of management experience in patient or customer-facing roles, ideally reimbursement of medical devices, healthcare or related field
• Robust interpersonal skills
• Solid decision-making abilities
• Strong ability to multi-task
• Excellent oral and written communication skills
• Proven ability to develop and manage teams
• Minimum of five years proven experience in related management position in healthcare industry
• Experience with Microsoft Word, Excel, and Outlook

Preferred Qualifications:

• Experience with Filemaker and Power BI
• Experience implementing systems to capture and report department metrics
• 4-year college degree

Physical Requirements:

• The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to use a computer and communicate with others.