Prior Authorization Manager at HISTOSONICS INC

Plymouth, Minnesota, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Jan, 26

Salary

0.0

Posted On

07 Oct, 25

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Payer Engagement, Process Improvement, Collaboration, Problem-Solving, Strategic Thinking, Data Analysis, Training Development, Healthcare Provider Interaction, Revenue Cycle Management, CPT Coding, ICD-10 Coding, Documentation Best Practices, Insurance Verification, Reimbursement Processes, Analytical Skills

Industry

Medical Equipment Manufacturing

Description

HistoSonics is a medical device company, founded in 2009, that has developed a non-invasive, sonic beam therapy platform that uses histotripsy, which is capable of destroying targeted liver tumors. Our mission and passion are to advance the novel science of histotripsy and its powerful benefits, bringing meaningful and transformational change to physicians and their patients. Location: Plymouth, MN (Remote, prefer near Plymouth, MN) Travel: Once per quarter, for a couple days at a time. Position Summary To support the successful growth of Histosonics commercialization the reimbursement team is seeking a Prior Authorization Manager to support Histosonics’ physician and hospital accounts. In this role, you will manage the prior authorization and claim appeal support team to optimize Histotripsy patient access and mitigate provider reimbursement barriers. You will lead and optimize the payer pre-service clearance process (and account claim denial support material) to ensure timely access to Histotripsy. You’ll guide prior authorization workflows, payer engagement strategies, and process improvements, serving as a key resource for both internal teams and external stakeholders. This position works closely with healthcare providers, payers, and the field sales team to streamline authorization processes, troubleshoot payer-related challenges, and develop best practices that improve efficiency and approval rates. The Prior Authorization Manager will also play a key role in data analysis reporting, training initiatives, and process optimization to enhance the effectiveness of the prior authorization function. This role will support the development of training programs, reporting tools, and strategic insights to drive operational excellence in prior authorization and payer access. Key Responsibilities * Lead and refine the prior authorization process, ensuring efficient and accurate submission of authorization requests and appeals * Act as a subject matter expert (SME) on prior authorization workflows, payer engagement strategies, and pre-service clearance best practices * Monitor and analyze payer authorization trends, identifying opportunities to improve internal processes and payer interactions * Serve as an escalation point for complex authorization denials, working with payers and providers to facilitate resolution * Collaborate with healthcare providers and revenue cycle teams to address documentation gaps and improve prior authorization success rates * Partner with the field sales team to provide guidance on payer requirements and develop strategies to support provider offices in securing approvals * Develop and refine training materials and educational programs for internal teams and provider offices on prior authorization best practices and payer requirements * Ensure compliance with HIPAA, payer policies, and regulatory requirements in all prior authorization activities * Maintain accurate reporting and dashboards, tracking authorization success rates, turnaround times, and payer-specific trends * Provide strategic insights to leadership on prior authorization challenges, policy trends, and opportunities for process optimization * Work cross-functionally to enhance the overall efficiency and effectiveness of the prior authorization function * Other duties as assigned Qualifications and Skills * Subject Matter Expertise - Serves as a functional leader in prior authorization strategy and payer engagement and ALJ hearings * Strategic Thinking - Identifies opportunities to refine workflows, improve efficiencies, and enhance the authorization process * Collaboration - Works cross-functionally with providers, payers, and internal teams to optimize patient access * Problem-Solving & Adaptability - Proactively addresses authorization challenges and navigates evolving payer landscapes * Process Improvement - Continuously assesses and enhances workflows to drive operational excellence * Experience with full prior authorization process (including 2nd and 3rd leave appeals, external reviews, peer-to-peer and administrative law judge review) necessary to guide the team through until all options for prior authorization/pre-determination have been exhausted. Minimum Qualifications * Education: Minimum Bachelor's degree required * Minimum 8 years of experience in prior authorization, commercial payer policy navigation, or revenue cycle management, preferably in medical device, neurostimulation, or rehabilitation therapies * 2+ years of experience managing a team * Category III CPT Code experience is strongly preferred * Experience with Salesforce®, EPIC Systems®, or other EHR/ERP systems is a plus * Coding Certifications is a plus * Expertise in prior authorization workflows, commercial payer appeals, and reimbursement processes, particularly outside of the payer portals. * Strong understanding of commercial insurance plans and their prior authorization requirements * Proficiency in CPT, HCPCS, and ICD-10 coding, as well as medical necessity documentation best practices * Experience with payer policy review, insurance verification, and authorization tracking systems Strong analytical skills with the ability to interpret payer data, identify trends, and develop strategic recommendations Benefits: We offer a comprehensive benefits package for full-time employees. This includes health, dental, and vision insurance, life, short-term and long-term disability insurance, 401(k), paid time off, and more. We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. #LI-Hybrid

Responsibilities

The Prior Authorization Manager will lead the prior authorization and claim appeal support team to optimize patient access to Histotripsy and mitigate reimbursement barriers. This role involves collaborating with healthcare providers and payers to streamline authorization processes and improve approval rates.