Prior Authorization Manager

TSAOG Orthopaedics & Spine•San Antonio, TX

2d•$41,600 - $60,736

About The Position

The Prior Authorization Manager is responsible for the strategic oversight, operational performance, and continuous improvement of the referral department, which encompasses both the professional and facility components of referral and authorization processes. This role ensures effective coordination across clinical, billing, and administrative teams while driving compliance, financial performance, and service excellence. The manager leads departmental planning, staff development, process optimization, and performance outcomes aligned with organizational goals.

Requirements

High School Diploma or equivalent required
Minimum of 5 years of experience in healthcare
At least 2 years in a management role
Strong knowledge of medical terminology, insurance processes, and regulatory requirements.
Excellent leadership and team management skills.
Exceptional communication and interpersonal abilities.
Proficient in using healthcare management software and electronic health records (EHR).
Strong analytical and problem-solving skills.
Ability to work in a fast-paced environment and manage multiple priorities effectively.
Requires regular and predictable attendance.

Nice To Haves

Bachelor’s degree in healthcare administration, nursing, or a related field preferred but not required.

Responsibilities

Provide full departmental leadership, including planning, directing, and evaluating all referral operations for the Group and Ambulatory Surgery Centers.
Establish and drive departmental strategy, goals, and performance benchmarks aligned with organizational priorities.
Develop, implement, and continuously improve policies, procedures, and workflows to ensure compliance and efficiency.
Serve as the primary liaison between Referral Operations, Billing, Clinical Teams, and Executive Leadership.
Oversee day-to-day operations and overall department performance, ensuring timely and accurate referral & authorization processing.
Lead resolution of complex operational issues, escalations, and cross-functional challenges.
Monitor and ensure quality and consistency in all referral-related workflows, including authorization and documentation processes.
Ensure proper use and optimization of the practice management system to support operational efficiency and reporting.
Drive the optimization and strategic utilization of EMR and practice management systems, identifying opportunities to automate processes, eliminate manual tasks, and improve workflow efficiency and data accuracy.
Lead system enhancement initiatives in partnership with IT and operational stakeholders to reduce inefficiencies, streamline referral workflows, and improve overall productivity and user experience.
Directly manage, coach, and develop supervisory and frontline staff within the referral department.
Oversee hiring, onboarding, training programs, and ongoing staff development initiatives.
Conduct performance evaluations, ensuring accountability and professional growth across the team.
Build a high-performing team culture focused on collaboration, accountability, and continuous improvement.
Develop, monitor, and report on key performance indicators (KPIs) and departmental metrics.
Analyze operational data to identify trends, gaps, and opportunities for process improvement.
Lead development and maintenance of dashboards and reporting tools to support leadership decision-making.
Ensure alignment of department performance with revenue cycle and patient access objectives.
Partner with Billing leadership to resolve systemic issues affecting revenue, claims, and authorizations.
Collaborate with physicians, clinical coordinators, and external partners to improve referral workflows and patient experience.
Serve as escalation point for patient concerns, payer issues, and external stakeholder challenges.
Ensure all referral processes meet regulatory, payer, and organizational compliance requirements.
Reviews monthly updates from health plans for changes to referral & authorization policies. Communicates and implements changes to process when needed.
Oversee accuracy of patient financial information, including benefits, authorizations, and eligibility data.
Drive initiatives to enhance patient satisfaction, communication, and access to care.
Identify and lead process improvement initiatives to enhance efficiency, quality, and financial outcomes.
Evaluate new tools, technologies, and workflows to modernize referral operations.
Lead change management efforts related to departmental or organizational initiatives.