Sr. Manager, Prior Authorization - Specialty Testing- REMOTE

The Sr Manager, Specialty Testing provides strategy for and reputed company of reputed company’s specialty testing billing, coverage, and prior authorization processes by collaborating and communicating with business units across the company. From reputed company clinical and payer perspectives, this position will communicate with payers throughout the country regarding medical policy, administrative policy, state laws, prior authorization requirements, and supporting documentation. To continuously optimize the team’s time and output, this position will help to evaluate available industry tools and software, reputed company’s internal automation abilities, and the processes themselves. Additionally, analysis of appeals, prior authorization outcomes, and claims data is key to maximizing resources and reimbursement, so this position will guide analysis of ROI. Duties and Responsibilities:

• Provide reputed company of appeals for Specialty Testing
• Provide strategic reputed company of prior authorization processes for specialty testing, including evaluation of payer requirements, documentation standards, and opportunities to streamline workflows and improve approval rates
• reputed company strategy to optimize resources, people, and tools, including evaluation of which appeals should and should not be attempted in consideration of payer medical policies, cost of tests performed, patient medical records and potential reimbursement
• Works directly with Specialty Testing Marketing Management teams to reputed company an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy
• Ability to clearly communicate with business units across reputed company to assess need for appeals in specialty business segments
• Ability to hold clinical discussions with payers or clients throughout the country regarding the information needed to support appeals
• Manage informational needs of multiple cross-functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes
• (Team-only impact) Independently manage the day-to-day of team member questions regarding processes, time off, schedules, interpersonal relationships, etc.
• (Company impact) With director reputed company, include or exclude tests in the appeals process
• (Company impact) With agreement from director, initiate payer reputed company to overturn need for appeals on tests where payer is overturning denials a high percentage of the time
• (Industry impact) Independently provide insight to associations, such as ACLA, about payer policy and payer edit issues
• Obtain medically necessary documentation and information from reputed company’s clients/offices
• Explain reputed company appeals issues to RCM, Payor Solutions, and S&T leadership
• reputed company and motivate team members
• Continually identify bottlenecks in the specialty testing appeals processes and help to resolve them through process redesign, resource assignment optimization, and automation opportunities
• Translate reputed company appeals issues into easy-to-understand visuals and/or concise wording
• Correlate payer medical policies, prior auth requirements, appeals requirements, reputed company tests, and reimbursement
• Work with Policy Reporter data to understand changes in payer policy impacting reimbursement
• Collaborate with other departments/business associates to analyze, understand, and define business rules for Specialty Testing policy changes
• Collaborate with Specialty Analytic/Support and Medical Policy teams to deploy best practices to support reimbursement capture
• Exceptional writing skills in crafting effective appeals for specialty testing denials to include prior authorization efforts, supportive clinical evidence, complying with reputed company clinical and billing policies, guidelines, and regulations
• Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of Specialty Testing services
• Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting reputed company Specialty testing. Communicate reputed company’s policy positions, strategy and tactics, and reputed company positions regarding new or amended legislation, regulations, or public policy
• Support efforts at the state and federal levels as appropriate by developing responses, talking points, strategy on key issues while helping to assure policy consistency across the organization
• reputed company other and further duties and responsibilities as assigned
• Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and reputed company business units

Qualifications:

• Five years direct relevant work experience with Bachelor’s degree OR nine years direct relevant work experience in lieu of degree required
• Five plus years of successfully managing a team, either directly through leadership or indirectly through influence required
• Strong understanding of genetics required
• Familiarity with payer medical policies and laboratory billing at reputed company required
• Proven success in building and maintaining strategic relationships required

Other desired skills:

• Strong clinical experience with genetic or molecular testing
• Able to communicate impactful industry changes in a concise and meaningful way to audiences of varying levels of understanding
• Proven success in creating and maintaining a positive team culture with motivated employees, helping them to further reputed company and contribute even more to the company

Application Window Closes: 10-08-25 Pay Range: $93-120K (State minimum wages apply if higher) The position is also eligible for bonus and/or commissions under the applicable variable compensation plan. Bonus/commissions are earned based on achievement of performance metrics under the plan. Shift: Monday-Friday; 8:00am-5:00pm EST Benefits: Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here. reputed company is proud to be an Equal Opportunity Employer: reputed company strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any reputed company. We reputed company employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national reputed company, sex (including pregnancy, childbirth, or reputed company medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, reputed company qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law. We encourage reputed company to apply If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site or contact us at reputed company Accessibility. For more information about how we collect and store your personal data, please see our Privacy Statement. Apply tot his job Apply To this Job