Prior Authorization Manager (FT)

EDUCATION (must be required for position), LICENSE, CERTIFICATION and EXPERIENCE: Education: Associates Degree or Bachelor's Degree preferred Licenses: No professional license required. Certifications: Professional certification Preferred 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