Manager of Authorizations

Job Summary

A company is looking for a Manager, Part C & Authorizations.

Key Responsibilities

• Oversee day-to-day adjudication operations to ensure compliance and quality output
• Establish and maintain reports to support service authorization processes and summarize findings
• Monitor encounter data submissions for accuracy and collaborate with cross-functional teams to resolve discrepancies

Required Qualifications

• 7+ years of experience in health insurance operations with team leadership experience
• Expertise in claims processing and utilization management
• Background in capitated health plan financials; PACE experience preferred
• Bachelor's degree in healthcare, finance, or related field required; Master's degree preferred
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)