Government Accounts Manager
Boston Imaging
Senior Manager, Prior Authorization – Specialty Testing
Labcorp
full-time
Posted on:
Location Type: Remote
Location: Remote • North Carolina • 🇺🇸 United States
Visit company websiteSalary
💰 $93,000 - $120,000 per year
Job Level
Senior
About the role
- Provide oversight of appeals for Specialty Testing
- Provide strategic oversight of prior authorization processes for specialty testing, including evaluation of payer requirements, documentation standards, and opportunities to streamline workflows and improve approval rates
- Develop strategy to optimize resources, people, and tools, including evaluation of which appeals should and should not be attempted
- Work directly with Specialty Testing Marketing Management teams to develop an understanding of existing and emerging technologies to provide education, appeals influence and insight pertaining to payer policy
- Communicate with payers throughout the country regarding medical policy, administrative policy, state laws, prior authorization requirements, and supporting documentation
- Manage informational needs of multiple cross-functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes
- Independently manage day-to-day team member questions regarding processes, time off, schedules, interpersonal relationships, etc.
- Obtain medically necessary documentation and information from Labcorp’s clients/offices
- Explain complex appeals issues to RCM, Payor Solutions, and S&T leadership
- Identify bottlenecks in the specialty testing appeals processes and help to resolve them through process redesign, resource assignment optimization, and automation opportunities
- Translate complex appeals issues into easy-to-understand visuals and/or concise wording
- Correlate payer medical policies, prior auth requirements, appeals requirements, Labcorp 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
- Conduct clinical evidence searches and utilize internal and external subject matter experts to identify supportive evidence for coverage of Specialty Testing services
- Maintain knowledge of regulatory processes and policy developments affecting Labcorp Specialty testing
- Communicate LabCorp’s policy positions and advocate regarding legislation, regulations, or public policy
- Perform other duties as assigned
Requirements
- 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 Labcorp required
- Proven success in building and maintaining strategic relationships required
- Strong clinical experience with genetic or molecular testing (desired)
- Ability to communicate impactful industry changes in a concise and meaningful way to audiences of varying levels of understanding (desired)
- Proven success in creating and maintaining a positive team culture with motivated employees (desired)
- Position may require travel (up to 20%)
Benefits
- Medical
- Dental
- Vision
- Life
- STD/LTD
- 401(k)
- Paid Time Off (PTO) or Flexible Time Off (FTO)
- Tuition Reimbursement
- Employee Stock Purchase Plan
- Eligibility for bonus and/or commissions under the applicable variable compensation plan
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
geneticslaboratory billingclinical evidence searchesprocess redesignresource assignment optimizationautomationpayer policy analysisdocumentation standardsprior authorization processesappeals management
Soft skills
team managementstrategic relationship buildingcommunicationproblem-solvinginfluencecollaborationleadershipinterpersonal skillscultural developmenteducation
