Prior Authorization Manager

Description

Sage Infusion is a rapidly growing infusion center with locations in central and southwest Florida.  At Sage, we’ve reimagined patient care.  From a quick start, to upfront pricing and financial assistance, to compassionate care by our clinical experts in a serene environment, patient experience infusion therapy like never before. 

The Prior Authorization Manager plays a pivotal leadership role in managing and enhancing the prior authorization process for infusion services.  This position is responsible for ensuring the accurate and timely submission and follow-up of prior authorization requests, optimizing reimbursement outcomes, and reducing claim denials.  The ideal candidate possesses deep expertise in payer policies, infusion therapy protocols, and demonstrated experience in team leadership and cross-departmental collaboration. Will be a remote position with the expectation to do a monthly meeting at our St. Pete office.

Responsibilities:

• Provide leadership and oversight to the Prior Authorization team, ensuring the efficient acquisition of insurance approvals for infusion therapies.  
• Oversee and provide expert guidance on prior authorizations for Alzheimer’s Disease therapies and other high-risk denial medications, ensuring robust clinical documentation, payer-criteria alignment, proactive appeals management, and minimized treatment delays for vulnerable patient populations. 
• Develop, implement, and continuously refine standardized workflows to streamline the prior authorization process and ensure compliance with payer guidelines. 
• Design and implement strategies to prevent prior authorization denials, including root-cause analysis of denial trends and continuous process improvement. 
• Ensure adherence to new and existing metrics related to PA approvals, turnaround times, denial rates, and appeal status. 
• Routinely review authorization workflows within the WeInfuse system to prevent backlogs on initial, pending or expiring authorization submissions.
• Collaborate proactively with Lead Insurance Support Specialists (ISS) to resolve authorization-related questions or issues across all locations. 
• Monitor daily operations, manage workload distribution, and track performance metrics to ensure timely and accurate authorization submissions. 
• Maintain up-to-date knowledge of payer-specific requirements, including Medicare Advantage plans and various commercial insurance plans. 
• Act as the primary escalation point for complex or delayed authorization issues, ensuring prompt resolution. 
• Coordinate with Intake, Clinical and Claims teams to support seamless and timely patient care. 
• Train, mentor and support professional development of Prior Authorization team members. 
• Lead monthly meetings with the Associate Director of Revenue Cycle Management to address pending patient authorizations, resolve team challenges, and promote interdepartmental collaboration. 
• Analyze trends in claims denials and partner with leadership to implement corrective strategies and process improvements. 
• Evaluate workflow efficiency, pilot new technologies or software as needed, and provide regular feedback to leadership. 
• Maintain and update key departmental documents, including the Prior Authorization Policy, Prior Auths spreadsheet and other reference materials, communicating updates to the team promptly. 
• Ensure full compliance with HIPAA and all relevant regulatory standards through proper documentation and process oversight. 

Requirements

• Bachelor’s degree in Healthcare Administration, Nursing, Business, or related field
• 5+ years of experience in healthcare operations, with at least 2 years in a supervisory role
• Strong knowledge of medical terminology, insurance processes, specialty pharmacy, and healthcare regulations. 
• Experience with insurance portals and prior authorization submission. 
• Excellent leadership and team management skills, virtual team leadership is a bonus.
• Strong problem-solving and analytical abilities
• Proficiency in healthcare software and Microsoft Office Suite
• Experience in customer service and conflict resolution
• Familiarity with infusion therapy or specialty pharmacy preferred

Sage Infusion is an Equal Opportunity Employer.  We are committed to creating an inclusive environment for all employees. 

Background Screening Requirement:

This position requires background screening through the Care Provider Background Screening Clearinghouse. For more information, visit:

https://info.flclearinghouse.com