Rady Children's Hospital San Diego Manager, Central Authorizations-50555 in San Diego, California

JOB SUMMARY:

The Central Authorizations Manager is responsible for the daily operations of Authorization functions for all governmental and commercial insurers for the Hospital and Medical Practice Foundation (MPF), including the management, prevention and timely resolution of 'front end' related claim Denials for the hospital and all authorization denials MPF. Responsibilities include, but are not limited to: Surgery prior authorization and insurance verification; Inpatient Admissions (scheduled and urgent/emergent) insurance verification and authorization; Specialty physician and clinic authorizations; external referrals for MPF; analysis and resolution of denials and development of denials prevention initiatives.

MINIMUM QUALIFICATIONS:

Bachelor's Degree in Business or Healthcare Administration, may be substituted by work experience

5 years of management experience

4 years of experience in a hospital, managed care insurance or healthcare-related field

Knowledge of state and federal claims, authorization protocols and regulatory requirements

Expertise related to understanding payor contracts and divisions of risk

PREFERRED QUALIFICATIONS:

Expertise of Medi-Cal, CCS, and Commercial HMO authorization protocols

Knowledge of state and federal government funding programs

Expertise and certification in EPIC systems