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RemoteFull-timeManagerIT
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New Zealand
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This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Manager Enterprise Authorization Services based in the United States.
This role leads enterprise authorization operations with a direct impact on revenue protection, patient access, and reimbursement performance.
You will manage a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
The position combines people leadership, revenue cycle expertise, data analysis, and process improvement in a complex healthcare environment.
You will identify authorization and denial risks, develop corrective action plans, and partner with departments across the organization to reduce preventable payment denials.
The role requires close collaboration with billing, registration, revenue cycle, clinical, and administrative teams.
You will also monitor regulatory changes, payer requirements, productivity, and authorization trends to strengthen operational performance.
This is an opportunity to lead a critical function that supports both financial sustainability and a smoother experience for patients and healthcare teams.
Lead and manage the authorization services team, including recruiting, onboarding, training, coaching, performance management, scheduling, workload allocation, and employee recognition.
Oversee insurance verification, pre-certification, and prior authorization activities for assigned services, ensuring work is completed accurately and within required timeframes.
Establish and maintain effective workflows and processes designed to improve authorization performance, strengthen reimbursement, and reduce payment denials.
Monitor team productivity, timeliness, quality, and compliance, conducting regular audits and implementing action plans when performance gaps are identified.
Communicate revenue risks, authorization delays, and operational barriers to departmental leaders and administrators, recommending practical mitigation strategies.
Maintain current knowledge of payer authorization requirements, Medicare and Medicaid rules, state and federal regulations, billing updates, and organizational compliance policies.
Monitor insurance authorization, reimbursement, and denial-management trends, using data to identify risks, measure progress, and guide process improvements.
Partner closely with hospital billing, professional billing, outpatient registration, revenue cycle, and other stakeholders to resolve complex authorization and denial issues.
Lead cross-functional initiatives to address barriers to completing authorizations and prevent avoidable payment denials.
Oversee front-end appeals and facilitate peer-to-peer processes for assigned hospitals and services when appropriate.
Analyze new services and determine applicable pre-authorization requirements and opportunities to reduce denials.
Identify opportunities to improve technology, systems, and workflows that can increase team productivity and operational effectiveness.
Represent authorization services in relevant internal and external meetings and communicate effectively with hospital personnel and other stakeholders.
Promote a collaborative, accountable, and patient-focused working environment while ensuring team members understand their responsibilities and performance expectations.
High school diploma or equivalent required.
At least 5 years of experience in healthcare accounts receivable management, billing, and collections.
At least 2 years of supervisory or people-management experience.
A bachelor's degree in Finance, Business Administration, or a related field is preferred.
Certified Healthcare Financial Professional (CHFP) certification through the Healthcare Financial Management Association (HFMA) is preferred.
Strong knowledge of healthcare authorization processes, managed care, utilization management, and inpatient and outpatient services.
Working knowledge of Medicare, Medicaid, commercial insurance plans, HMOs, PPOs, and applicable state and federal regulatory requirements.
Familiarity with UB-04 forms, itemized billing, grievance procedures, utilization management processes, and payer requirements.
Knowledge of medical terminology and the ability to interpret clinical information and medical records.
Familiarity with CPT, ICD-9/ICD-10, and DRG coding concepts.
Experience with healthcare information systems and the ability to use data effectively to support administrative and operational decisions; experience with Epic is preferred.
Strong analytical and problem-solving abilities, particularly in identifying revenue risks, authorization barriers, and denial trends.
Excellent organizational skills, attention to detail, initiative, and follow-through.
Strong communication and interpersonal skills, with the ability to collaborate effectively across clinical, administrative, billing, and revenue cycle functions.
Ability to hold team members accountable for performance and address issues that may contribute to lost revenue or preventable denials.
Demonstrated ability to work collaboratively while maintaining a high level of ownership and professional judgment.
Work arrangement: Remote position in the United States.
Schedule: Full-time, 40 hours per week.
Employment status: Exempt.
Leadership opportunity: Manage and develop a team within an important enterprise authorization function.
Professional impact: Direct opportunity to improve revenue protection, reimbursement performance, authorization timeliness, and patient access.
Cross-functional exposure: Collaborate with billing, registration, revenue cycle, clinical, and administrative teams across a complex healthcare environment.
Professional development: Opportunities to strengthen expertise in healthcare revenue cycle management, authorization, denial prevention, and regulatory compliance.
Technology and analytics: Work with healthcare systems, operational data, and process-improvement initiatives to enhance performance and productivity.
Mission-driven environment: Contribute to healthcare operations that support patients, providers, and the financial sustainability of care delivery.