Director of Outpatient Authorizations and Referrals

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary Responsible for overseeing the financial clearance operations to ensure patient eligibility, benefits verification, and authorization processes are accurately managed. Ensures efficient and compliant financial clearance workflows that support revenue cycle goals and improve the patient experience.

Essential Functions:

• Leads financial clearance operations, including eligibility verification, benefits coordination, and prior authorization processes.

• Collaborates with patient access, billing, and managed care teams to optimize workflows and reduce delays.

• Develops and implements policies to ensure compliance with regulatory requirements and payer guidelines.

• Monitors financial clearance performance metrics, identifying and addressing areas for improvement.

• Manages relationships with payers and other stakeholders to resolve issues related to coverage and authorizations.

• Oversees the training and development of financial clearance staff, fostering a knowledgeable and service-oriented team.

• Analyzes trends in denials and authorizations, developing strategies to minimize financial risk.

• Prepares reports for senior leadership on financial clearance activities and performance.

• Ensures the accuracy and efficiency of data collection and documentation for patient financial records.

Qualifications

Education

• Bachelor's Degree in Healthcare Administration, Business, Finance or related field of study required

• Master's Degree in a related field of study preferred

Experience

• 8+ years of experience required in financial clearance, revenue cycle management, contract management, or other closely related role, preferably in a managed care setting

• 5+ years of experience in a management or leadership role required

Knowledge, Skills and Abilities

• Strong understanding of payer regulations, authorizations, and managed care requirements.

• Proficiency in healthcare revenue cycle processes and systems.

• Analytical skills to assess financial data and operational metrics.

• Effective communication and collaboration skills to work with cross-functional teams and external partners.

• Leadership abilities for team management and staff development.

Additional Job Details (if applicable)

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range $124,342.40 - $180,897.60/Annual

Grade 9

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.