Prior Authorization Lead

About the role

We are seeking a Prior Authorizations Lead to design, manage, and scale 3Y Health’s prior authorization operations. The ideal candidate will be an operational problem-solver who thrives on efficiency and loves turning complexity into clarity. This role requires a strategic yet hands-on operator who can build scalable systems, streamline workflows, and ensure timely, accurate approvals for our clinician partners across multiple specialties.

Responsibilities

• Lead the end-to-end prior authorization process, including verification, documentation, submission, and follow-up with payers.
• Build and optimize workflows that minimize turnaround times and maximize approval rates across multiple specialties.
• Partner with Product and Engineering to identify automation opportunities and develop tools that reduce manual work.
• Collaborate with RCM and Operations teams to ensure clean handoffs between authorizations, billing, and patient care coordination.
• Develop and track KPIs to monitor authorization performance, identify bottlenecks, and continuously improve process efficiency.
• Train and manage a growing team or vendor partners to ensure consistent execution and adherence to payer guidelines.
• Maintain up-to-date knowledge of payer requirements, clinical criteria, and regulatory changes that impact authorization processes.
• Build documentation, playbooks, and SOPs to support scaling into new states, payers, and clinical verticals.

Qualifications

• Bachelor’s degree required
• 5–8 years of experience in healthcare operations, prior authorization management, or related RCM functions
• Strong understanding of payer requirements, medical necessity documentation, and authorization workflows
• Proven ability to lead cross-functional initiatives and manage complex, high-volume processes
• Analytical and systems-oriented thinker with a track record of driving measurable improvements in turnaround times and accuracy
• Experience with automation tools or EMR/EHR integrations a plus