Director of Authorization and Pre-Certification Job Listing at MedStar Medical Group in Baltimore, MD (Job ID req46634)

Description

General Summary of Position
The Director of Authorization and Pre-Certification for Surgical, Diagnostic, and Infusion Services is responsible for the strategic leadership and operational oversight of pre-service authorization and pre-certification for all scheduled procedures across hospital and ambulatory locations. This includes surgical cases, diagnostic imaging, infusion therapy, and other non-surgical outpatient services. The Director ensures timely and accurate completion of prior authorizations to prevent denials, reduce financial risk, and ensure seamless patient access. This role oversees cross-functional collaboration with scheduling, clinical, and financial clearance teams, and leads process improvements, automation initiatives, and compliance monitoring across all modalities requiring pre-approval.

Primary Duties and Responsibilities

Minimum Qualifications
Education

• Bachelor's degree Healthcare Administration, Business, Nursing required
• Master's degree Healthcare Administration, Business, Nursing preferred
• One year of relevant education may be substituted for one year of required work experience.

Experience

• 8-10 years Hospital revenue cycle or patient access operations required and
• 5-7 years Managing prior authorization and pre-certification for surgical and non surgical services including diagnostic and infusion required and
• 5-7 years Demonstrated success in managing high-volume pre-service operations in a multi-facility health system required or
• 10+ years Bachelor's Degree requirement may be substituted with relevant experience, including at least 5 years in a leadership role within pre-service, financial clearance, or revenue cylce operations required or
• 3-4 years Master's Degree may be offset by extensive leadership experience, performance improvement work in a hospital system. preferred
• One year of relevant professional-level work experience may be substituted for one year of required education.

Licenses and Certifications

• CHAM - Certified Healthcare Access Manager within 1 Year preferred
• Cert Revenue Cycle Rep - CRCR within 1 Year preferred
• Epic Authorization Module Certification preferred
• Lean Six Sigma or PMP preferred

Knowledge, Skills, and Abilities

• Deep knowledge of payer authorization requirements for surgical, imaging, and infusion services.
• Strong leadership, communication, and change management skills.
• Experience with Epic, MedConnect, IDX, or other EHR and payer portals, and authorization platforms.
• Proficiency in analyzing trends, KPIs, and denial data to drive improvements.

This position has a hiring range of $111,779 - $212,513