Prior Auth & Scheduling Manager

Community Hospital•Grand Junction, CO

14d•Onsite

About The Position

The Prior Authorization & Scheduling Manager will provide day-to-day leadership and management of the combined Prior Authorization and Scheduling teams. This role is responsible for ensuring both teams meet productivity and quality standards, building and maintaining staff work schedules, and designing and delivering training programs. The manager will oversee prior authorization and scheduling operations, ensuring optimal resource utilization, efficient patient flow, and compliance with regulations. This position serves as the point of escalation for issues related to prior authorizations or scheduling and is responsible for documentation, reporting, and policy development.

Requirements

Associate's degree in a healthcare-related field required; Bachelor's degree preferred, or equivalent combination of education and experience.
(2-3) years of experience in prior authorization and/or patient scheduling operations required; supervisory or lead experience preferred.
Demonstrated experience building and managing staff work schedules, coverage plans, and time-off approvals across multiple teams.
Experience developing and delivering staff training programs, including onboarding and ongoing competency development.
Strong knowledge of healthcare regulations, payer policies, and prior authorization/scheduling compliance requirements.
Excellent communication, leadership, coaching, and interpersonal skills.
Attention to detail and the ability to maintain accuracy in a fast-paced, multi-team environment.
Proficiency with relevant software and tools used in prior authorization, scheduling, and workforce/staff scheduling management.

Nice To Haves

Bachelor's degree preferred
supervisory or lead experience preferred

Responsibilities

Provide day-to-day leadership and management of the combined Prior Authorization and Scheduling teams, including hiring, performance management, coaching, and disciplinary action as needed.
Ensure both teams meet productivity and quality standards.
Build, publish, and maintain staff work schedules for both teams, including shift coverage, rotation of priority coverage, and approval of time-off requests, to ensure adequate staffing across all business hours.
Design, deliver, and continuously improve onboarding and ongoing training programs for Prior Authorization Specialists and Schedulers.
Ensure all staff maintain current knowledge of regulations, payer policies, and scheduling procedures.
Understand and stay up-to-date with the prior authorization process for medical services and with scheduling requirements for patient appointments, procedures, and surgeries.
Maintain expertise in insurance policies, authorization criteria, and scheduling protocols.
Oversee the scheduling process to ensure optimal utilization of resources and efficient patient flow.
Monitor scheduling and authorization activity to ensure accuracy, timeliness, and compliance with organizational policies and regulatory requirements.
Address conflicts, discrepancies, and challenges proactively.
Facilitate effective communication within and between both teams, and with healthcare providers, patients, and insurance companies.
Serve as the point of escalation for issues, questions, or concerns related to prior authorizations or scheduling.
Maintain accurate records of prior authorization and scheduling activity and outcomes.
Generate and review reports to track performance metrics, staffing levels, and compliance for both functions.
Ensure that both teams adhere to all relevant healthcare regulations and maintain the highest level of accuracy and confidentiality in their work.
Assist in resolving complex cases, denials, scheduling conflicts, or escalated issues that require a higher level of expertise or managerial authority.
Collaborate with senior leadership to develop and update prior authorization and scheduling policies and procedures in alignment with industry best practices.
Identify and implement process improvements to maximize efficiency and minimize processing and wait times.