Sr. Manager, Prior Authorization - Specialty Testing- REMOTE

The Sr Manager, Specialty Testing provides strategy for and oversight of Labcorp’s specialty testing billing, coverage, and prior authorization processes by collaborating and communicating with business units across the company.

From experienced clinical and payer perspectives, this position will communicate with payers throughout the country regarding medical policy, administrative policy, state laws, prior authorization requirements, and supporting documentation.

To continuously optimize the team’s time and output, this position will help to evaluate available industry tools and software, Labcorp’s internal automation abilities, and the processes themselves. Additionally, analysis of appeals, prior authorization outcomes, and claims data is key to maximizing resources and reimbursement, so this position will guide analysis of ROI.

Duties and Responsibilities:

• 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 in consideration of payer medical policies, cost of tests performed, patient medical records and potential reimbursement
• Works 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
• Ability to clearly communicate with business units across Labcorp to assess need for appeals in specialty business segments
• Ability to hold clinical discussions with payers or clients throughout the country regarding the information needed to support appeals
• Manage informational needs of multiple cross-functional stakeholders regarding payer coverage and reimbursement policy issues and/or changes
• (Team-only impact) Independently manage the day-to-day of team member questions regarding processes, time off, schedules, interpersonal relationships, etc.
• (Company impact) With director oversight, include or exclude tests in the appeals process
• (Company impact) With agreement from director, initiate payer outreach to overturn need for appeals on tests where payer is overturning denials a high percentage of the time
• (Industry impact) Independently provide insight to associations, such as ACLA, about payer policy and payer edit issues
• Obtain medically necessary documentation and information from Labcorp’s clients/offices
• Explain complex appeals issues to RCM, Payor Solutions, and S&T leadership
• Empower and motivate team members
• Continually 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
• Exceptional writing skills in crafting effective appeals for specialty testing denials to include prior authorization efforts, supportive clinical evidence, complying with all clinical and billing policies, guidelines, and regulations
• Conduct clinical evidence searches, utilize internal and external subject matter experts and/or other avenues of research to identify supportive evidence for coverage of Specialty Testing services
• Maintain a thorough knowledge of regulatory processes and policy developments on matters affecting Labcorp Specialty testing. Communicate LabCorp’s policy positions, strategy and tactics, and advocate positions regarding new or amended legislation, regulations, or public policy
• Support efforts at the state and federal levels as appropriate by developing responses, talking points, strategy on key issues while helping to assure policy consistency across the organization
• Perform other and further duties and responsibilities as assigned
• Position may require travel (up to 20%) to meet face-to-face with payers, industry leaders, and LabCorp business units

Qualifications:

• Five years direct relevant work experience with Bachelor’s degree OR nine years direct relevant work experience i