Manager, Healthcare

Location: Mohali

Manager – Practice Support Services (US Medical Billing)

Job Summary

The Manager – Practice Support Services is responsible for overseeing and managing end-to-end prior authorization and referral processes across multiple provider practices. The role ensures timely approvals, adherence to payer guidelines, SLA compliance, and seamless coordination with internal practice support functions. This leadership position focuses on optimizing authorization workflows, reducing authorization-related denials, and supporting overall revenue cycle performance.

Key Responsibilities

Leadership and Strategy:
Develop and execute strategic plans to strengthen authorization processes within Practice Support Services.
Align authorization team objectives with organizational goals, client SLAs, and practice-level KPIs.
Provide mentorship and performance guidance to Assistant Managers, Team Leads, and authorization specialists.
Evaluate team capacity, productivity, and resource utilization based on practice volumes and payer mix.
Foster a quality-driven, accountable, and high-performance team environment.
Proactively reduce authorization-related delays and downstream billing and AR impacts.

Operational Management:
Oversee end-to-end authorization workflows including prior authorizations, referrals, retro authorizations, and eligibility coordination.
Ensure timely submission, tracking, and follow-up of authorizations as per payer turnaround times.
Coordinate closely with Scheduling, Coding, Billing, and AR teams to ensure continuity of Practice Support Services.
Monitor daily operations, aging, approval rates, and backlog to meet client and internal SLAs.
Identify operational gaps and implement continuous improvement initiatives to improve first-pass approval rates.

Compliance and Quality Assurance:
Ensure compliance with HIPAA regulations, payer-specific authorization policies, and client-defined workflows.
Establish and monitor quality benchmarks to minimize rework, rejections, and authorization-related denials.
Conduct regular audits and root cause analysis for authorization denials and escalations.
Stay updated with payer policy changes and industry best practices relevant to Practice Support Services.

Stakeholder Engagement:
Act as the primary escalation point for authorization-related issues within Practice Support Services.
Engage with internal stakeholders and clients to resolve complex authorization challenges.
Support onboarding of new practices by defining authorization workflows, baseline metrics, and payer strategies.
Represent Practice Support Services in cross-functional and leadership discussions.
Data Analysis and Reporting:
Analyze authorization and practice-level data to identify trends, risks, and improvement opportunities.
Prepare and present MIS, dashboards, and performance reports to senior leadership and clients.
Use data insights to optimize staffing models, turnaround times, and payer-specific strategies.
Problem-Solving and Decision-Making:
Handle complex authorization cases involving medical necessity reviews and payer escalations.
Lead resolution efforts during operational challenges such as high volumes, payer system outages, or urgent practice needs.
Prioritize tasks and resources to ensure critical authorizations are completed within SLA timelines.

Qualifications and Skills:

Must be a college graduate (any discipline) with  8–10 years of experience in US Healthcare Authorizations / Practice Support Services  and  5+ years in a managerial role .
Strong understanding of prior authorization requirements across multiple provider specialties.
Proficient in authorization portals, payer websites, billing software, and EHR systems.
Strong analytical, leadership, and stakeholder management skills.
Ability to work independently while leading cross-functional Practice Support teams.
In-depth understanding of KPIs impacting authorization TAT, approval rates, and denial prevention.

Location;
Mohali, Punjab