Manager - Prior authorization (US Healthcare)

About the Role:

We are looking for a result-oriented Pre-Authorization Manager for a leading US Healthcare company

Key Responsibilities:

Operational Oversight

• Manage end-to-end Prior Authorization workflows, from initial request to final approval.
• Ensure timely processing of authorizations with high accuracy and compliance standards.

Team Management

• Lead and mentor a team of Assistant Managers and Team Leaders.
• Drive operational performance metrics and KPIs.
• Conduct regular performance reviews and process improvement initiatives.

Compliance

• Stay updated with CMS guidelines, CPT/ICD-10 coding changes, and payer-specific medical policies.
• Ensure adherence to HIPAA and other US healthcare regulatory standards.

Denial Strategy

• Analyze trends related to Authorization Required denials.
• Implement proactive root-cause analysis and preventive action plans to reduce denials.

Desired Candidate Profile

• 10 to 14 years of experience in:

• Prior Authorization

• Eligibility Verification

• Insurance Verification

• Related US Healthcare processes

• Strong understanding of US healthcare regulations and industry standards, including HIPAA.

• Excellent analytical and problem-solving skills.

• Ability to interpret complex operational data and identify improvement areas.

• Hands-on experience with Electronic Health Record (EHR) systems such as Epic Systems or similar platforms.

Designation Criteria

Candidates should currently be:

• In a Deputy Manager role for at least 1 year,
  OR
• In an Assistant Manager role for 2+ years

How to Apply:

Interested candidates meeting the above criteria can share their updated CV

Contact Details

Email: [email protected]
WhatsApp: 8885935810