Prior Authorization Manager

About the Role:

The Prior Authorization Manager oversees daily prior authorization operations. The Manager partners with leadership and cross-functional teams to maintain consistent authorization workflows and achieve departmental goals.

• High School Diploma required.
• Bachelor’s degree preferred, business, nursing, health information or organizational management preferred.
• Minimum of 5 years of experience in prior authorization, medical billing, or healthcare operations.
• Strong knowledge of insurance plans, payer requirements, and healthcare regulatory standards.
• Proven leadership or supervisory experience managing teams in a healthcare setting.
• Excellent communication and organizational skills.
• Experience with electronic health record (EHR) systems and prior authorization software platforms.
• Familiarity with Medicare, Medicaid, and commercial insurance prior authorization protocols.

• One of the below certifications within two years of position start date preferred.
  • Certified Patient Access Manager (CPAM)
  • Certified Healthcare Access Associate/Manager (CHAA/CHAM)
  • Certified Patient Access Specialist (CPAS)
  • Certified Revenue Cycle Executive (CRCE)
  • American Health Information Management Association (AHIMA)
  • Healthcare Financial Management Association (HFMA)
  • American Association of Healthcare Administrative Management (AAHAM)

• Lead and supervise the prior authorization team to ensure timely processing and approval of authorization requests.
• Develop, implement, and monitor policies and procedures related to prior authorization activities to maintain compliance with payer and regulatory requirements.
• Collaborate with healthcare providers, insurance representatives, and internal departments to resolve authorization issues and expedite approvals.
• Analyze authorization data and trends to identify bottlenecks, reduce denials, and improve overall process efficiency.
• Train and mentor staff on best practices, payer guidelines, and system updates to maintain high-quality service delivery.
• Manage communication and documentation related to prior authorization requests, appeals, and denials.
• Stay current with changes in healthcare regulations, insurance policies, and industry standards affecting prior authorization.

A conditional job offer is contingent upon successfully passing a pre-employment drug test and background checks. A Physical Capacity Profile may be required for some positions.