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

Salary : $29