Prior Authorization Manager

1. About Our Client:The organization operates in the cardiology healthcare sector, focusing on supporting independent cardiology practices. It addresses challenges faced by these practices in a changing healthcare environment by providing technology, operational infrastructure, and expertise. The organization integrates services such as operations, revenue cycle management, imaging, and practice development to enhance growth, efficiency, and patient outcomes. It is backed by healthcare investors and leadership to build a scalable management services organization for cardiology. 2. About the Opportunity:The Prior Authorization Manager is responsible for overseeing the prior authorization processes across a network of cardiology practices. This role ensures effective authorization outcomes, manages vendor relationships, and supports internal operations at scale, particularly during new practice launches. The position impacts the organization by maintaining compliance and performance in authorization workflows, contributing to efficient care delivery and revenue management. 3. Responsibilities:Manage and improve the authorization tracking system ensuring accuracy and visibilityMonitor authorization approval rates and denial trends, driving corrective actionsDevelop and enforce standardized workflows and documentation requirementsCoordinate authorization activities across internal teams and external vendorsServe as primary liaison to third-party authorization vendors, enforcing service standardsConduct vendor performance reviews and escalate issues as neededEnsure timely access to necessary clinical and payer information for vendorsOversee CTA add-on authorization workflows outside standard pathwaysMonitor compliance with clinical criteria and order sets for specialized authorizationsManage authorization workflows for new practice onboarding including vendor coordinationProvide oversight, training, and feedback to authorization staffCollaborate with cross-functional teams to resolve authorization-related issuesContribute to reporting on authorization performance and vendor adherenceMaintain oversight of urgent authorization processes and facility notification requirements 4. Requirements:Minimum of 5 years’ experience in prior authorization or related healthcare operationsStrong knowledge of authorization processes and healthcare payer requirementsExperience managing vendor relationships and coordinating multiple workflowsAbility to analyze data and drive performance improvementsSkilled in cross-functional collaboration and team leadership 5. Pay Range and Compensation Package:The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.