Medical Prior Authorizations Manager - Hybrid

WHO WE ARE:

AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us.

We’re looking for passionate, driven innovators to join our mission. If you thrive on challenge, love taking action, and get up every day ready to make a difference, apply now. Learn more at www.ac3health.com

COMPANY MISSION: To help specialty practices thrive.

POSITION SUMMARY: The Manager, Medical Prior Authorizations, is responsible for overseeing the daily operations of the prior authorization department, ensuring timely and accurate processing of authorization requests for medical services and procedures. This role involves managing staff, optimizing workflows, and maintaining compliance with payer guidelines and organizational policies to support the delivery of high-quality patient care and maximize reimbursement outcomes.

Essential Function and Job Responsibilities

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Supervise and lead the prior authorization team, including hiring, training, performance evaluation, and ongoing staff development.
• Develop, implement, and optimize prior authorization workflows to ensure efficiency, accuracy, and timely submission of authorization requests.
• Monitor daily workload distribution and adjust staffing assignments as needed to maintain productivity and service level agreements (SLAs).
• Serve as the primary point of contact for escalated authorization issues, collaborating with clinical teams, payers, and patients to resolve delays or denials.
• Ensure compliance with payer requirements, HIPAA regulations, and organizational policies related to prior authorizations and patient information.
• Maintain up-to-date knowledge of insurance coverage policies, authorization requirements, and industry changes.
• Collaborate with the Director to analyze key performance metrics, prepare reports, and recommend process improvements to leadership.
• Collaborate with revenue cycle and clinical teams to improve communication and reduce authorization-related delays.
• Develop and maintain standard operating procedures (SOPs), client deliverables, and training materials for the department with the Director and Application Specialists.
• Participate in payer audits and assist with the resolution of audit findings related to prior authorizations in coordination with the other revenue cycle departments.

POSITION REQUIREMENTS

• Bachelor’s degree or equivalent experience in Medical Office Management.
• Five years’ experience in increasingly responsible positions in healthcare leadership roles.
• Three years' experience in healthcare medical authorization environment.
• Ability to manage multiple billing systems in a fast-paced environment.
• Experience with payer portals and automated prior authorization tools.
• Accurately maintains and adheres to all safety rules and regulations.
• Must be detail oriented and have problem solving abilities.
• Proficient in Microsoft Office preferred.
• Working knowledge/experience in electronic medical records and/ or other medical software if applicable.
• Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner.
• Must rely on experience and judgment to plan and accomplish goals.
• Excellent communication and organizational skills with the ability to work in a fast-paced environment; prioritize tasks and workloads.
• Performs other duties as assigned.

WORK LOCATION: This is a full-time hybrid/remote position; meaning, there will be required onsite training and a combination of a remote and onsite work. The ideal candidate will reside within a 30-mile radius of the office located in South Bend, IN.

Work is completed in a general office environment, sedentary in nature but may require standing and walking for up to 10% of the time. The work environment is favorable with adequate lighting and temperature, and no hazardous or unpleasant conditions caused by noise, dust, etc. Must be able to operate standard office equipment and keyboards.

Why Work at AC3? When you become an AC3 Team member, you can expect ongoing training, support, and a work culture like no other. We offer our Full-Time Team Members medical, dental and vision health and wellness benefits, along with employer paid life insurance, long and short-term disability policies. Because our team’s health and wellness are our priority, we start new hires off with an above average paid time out plan and offer a comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support. We also provide all Team Members with access to company sponsored financial wellness counselors, employee assistance services and the opportunity to enroll in our company-matched, 401k plan.

Come join our Winning Team!