Authorization Manager

PT Solutions Physical Therapy

About The Position

The Authorization Manager oversees the full Authorization department, ensuring timely and accurate processing of prior authorizations across all PT Solutions private practice and hospital-based clinics. This role provides strategic and operational leadership to Supervisors, Leads, and Authorization Specialists to ensure exceptional performance in turnaround times, accuracy, productivity, and payer compliance. The Authorization Manager is responsible for developing workflows, managing capacity and staffing, driving continuous improvement, and collaborating closely with Scheduling, Verification, Billing, Clinical Operations, Compliance, and external partners. The Manager analyzes trends, payer policy changes, and denial patterns to ensure clean claim submission and an optimal patient experience. This position requires a strong operational mindset, deep knowledge of payer authorization processes, proven leadership capabilities, and the ability to drive high performance across a large, fast-paced department.

Requirements

Strong leadership, coaching, and team-development skills.
Excellent written and verbal communication with ability to influence cross-functional partners.
Advanced problem-solving, analytical, and decision-making skills.
Ability to manage multiple priorities, delegate effectively, and maintain accountability across a large team.
Proficiency in Microsoft Office (Excel, Word, Outlook) and data reporting tools.
Ability to interpret and apply federal, state, payer, and organizational policies.
High degree of professionalism, discretion, and confidentiality.
Strong customer service orientation and commitment to operational excellence.
Ability to thrive in a fast-paced, high-volume environment with evolving priorities.
Bachelor’s degree in Healthcare Administration, Business, or related field preferred (or equivalent experience).
Minimum 5 years of authorization, insurance verification, medical billing, or revenue cycle experience required.
Minimum 2–3 years of supervisory or management experience in a healthcare or revenue cycle environment.
Advanced knowledge of insurance authorization processes, medical necessity requirements, ICD-10, CPT, and payer guidelines.
Experience with EMR systems, payer portals, and analytics tools.
Strong financial and operational acumen, with experience managing department budgets and productivity standards.
Proven track record of driving performance, improving workflows, and developing high-performing teams.

Responsibilities

Provide overall leadership and direction to the Authorization team, including Supervisors, Leads, and Specialists.
Establish departmental goals, KPIs, and performance expectations to ensure operational excellence.
Conduct coaching, performance evaluations, and corrective action as needed.
Lead workforce planning, staffing, talent development, and succession planning.
Foster a positive, accountable, and service-driven team culture.
Oversee daily operations to ensure timely and accurate processing of authorizations, including standard, urgent, and retro requests.
Develop, maintain, and optimize workflows, SOPs, and training materials.
Monitor payer changes, audit trends, and regulatory updates to ensure compliance.
Ensure escalation pathways are clear and effectively managed.
Collaborate with internal teams to reduce downstream claim denials and improve clean claim rates.
Manage departmental KPIs, including turnaround time, accuracy, productivity, rollover rate, and denial impact.
Analyze operational trends and develop action plans to address risks or performance gaps.
Prepare weekly, monthly, and quarterly performance reports for leadership.
Utilize data to drive decision-making and operational improvements.
Partner with Scheduling, Verification, Billing, Clinic Operations, Compliance, and Payer Relations to align workflows and resolve issues.
Support major initiatives including market conversions, new payer contracts, new clinic onboarding, and EMR updates.
Offer insights into payer policy changes, denial trends, and process gaps affecting reimbursement or patient access.
Oversee development and delivery of training programs for onboarding and ongoing education.
Ensure quality audits are completed regularly and corrective action plans are implemented.
Promote a culture of continuous improvement and standardization across all markets and teams.
Lead or participate in projects related to system upgrades, EMR changes, payer policy shifts, and organizational initiatives.
Drive process improvements aimed at efficiency, accuracy, and reduced authorization-related denials.
Serve as a subject matter expert (SME) for authorization workflows in cross-department projects.
Respond to escalated payer or clinic issues and resolve them in a timely, professional manner.
Support Director-level leadership in the creation and implementation of strategic initiatives.
Perform other duties as assigned to support revenue cycle excellence and organizational priorities.