Manager, Prior Authorizations

The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignity.

Innovating versatile new ways to deliver care, Kestra is helping patients and their care teams harmoniously monitor, manage, and protect life.

This leadership position is accountable for overseeing all aspects of the organization’s prior authorization team and processes including timely and accurate prior authorization submission and appeal, identifying clinical relevance within each order as it relates to Local Coverage Determination, communicating outcomes timely and effectively, trending, and achieving targeted metrics to optimize outcomes. This leader will also be responsible for overseeing and managing the organization’s third-party vendor relating to aspects of the prior authorization process and will monitor and validate adherence to Policies and Procedures.

• Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions
• Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate
• Work across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination
• Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization
• Ensure that all metrics are achieved and, develop actionable plans that will quickly and efficiently resolve deficits should those occur
• Provide department orientation and ongoing training for all in/direct reports
• Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains
• Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage
• Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results
• Adhere to Pledge of Confidentiality
  • Information regarding a patient of this company shall not be released to any source outside of this company
    without the signed permission of the patient. Furthermore, information will only be released internally on a needto
    - know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by
    this company unless they are directly involved with the patient’s case.

• Passion:
  Contagious excitement about the company – sense of urgency. Commitment to continuous improvement.
• Integrity:
  Commitment, accountability, and dedication to the highest ethical standards.
• Collaboration/Teamwork:
  Inclusion of Team Member regardless of geography, position, and product or service.
• Action/Results:
  High energy, decisive planning, timely execution.
• Innovation:
  Generation of new ideas from original thinking.
• Customer Focus:
  Exceed customer expectations, quality of products, services, and experience always present of mind.
• Emotional Intelligence:
  Recognizes, understands, manages one’s own emotions and is able to influence others. A critical skill for pressure situations.

• 3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management
• Strong understanding of clinical review and prior authorization management
• Proven record of achieving aggressive metrics and outcomes

• 10+ years of leading revenue cycle management functions
• Experience in vendor management or offshore staff augmentation relationships

• Directly manage Prior Authorization team members including but not limited to conducting performance reviews, providing feedback, and…