Prior Authorization Manager (FT)

EDUCATION

(must be required for position), LICENSE, CERTIFICATION and

EXPERIENCE

1.

Education:

Associates Degree or Bachelor's Degree preferred 2.

Licenses:

No professional license required. 3.

Certifications:

Professional certification Preferred 4.

Experience:

Two years of Prior Authorization and Eligibility experience Required

REQUIRED SCREENINGS

• Drug Screen
• Physical Assessment
• Tuberculosis screen
• Background check (Criminal, Civil, Educational, Previous Employment, etc.)
• Driver Record screen (positions requiring on-the-job driving)

ESSENTIAL FUNCTIONS

• Reliable and punctual attendance is essential; expected to be at job as scheduled each day.
• Communicate necessary information to others as appropriate. Operational Leadership
• Manage day-to-day prior authorization activities, ensuring productivity, accuracy, and compliance standards are consistently met.
• Supervise, coach, and develop team members to achieve performance goals and maintain high engagement.
• Establish clear expectations and accountability measures across the team. KPI Development & Performance Management
• Develop, implement, and monitor KPIs to evaluate team and process performance (e.g., turnaround time, approval rates, denial rates, first-pass resolution).
• Use KPI dashboards to identify gaps, measure success, and drive data-informed decision-making.
• Regularly report performance metrics to leadership with actionable insights and recommendations. Process Improvement & Auditing
• Conduct ongoing audits of current prior authorization workflows to identify inefficiencies, compliance risks, and opportunities for optimization.
• Lead process improvement initiatives using metrics and industry standards.
• Standardize best practices and ensure consistent implementation across the department. Data Analysis & Trend Identification
• Collect, analyze, and interpret data to identify trends, patterns, and root causes of issues such as denials or delays.
• Develop and maintain reporting tools to track volume, payer behavior, and team performance.
• Partner with leadership to proactively address trends and implement corrective actions. Compliance & Quality Assurance
• Ensure adherence to payer requirements, regulatory guidelines, and internal policies.
• Oversee quality assurance programs, including routine audits and feedback loops to maintain accuracy.
• Stay current on industry changes and update processes accordingly. Cross-Functional Collaboration
• Collaborate with clinical, billing, and administrative teams to streamline prior authorization processes and improve patient and provider experience.
• Serve as a liaison between departments and external stakeholders, including payers.

Wage starts at $29.00 per hour and goes up base on experience