Prior Authorization Manager (FT)

Family Health West•Fruita, CO

About The Position

The Prior Authorization Manager is responsible for the operational leadership of prior authorization activities, ensuring high standards of productivity, accuracy, and compliance. This role involves supervising, coaching, and developing team members, establishing and monitoring Key Performance Indicators (KPIs), and driving data-informed decision-making. The manager will lead process improvement initiatives, conduct audits, analyze data to identify trends, and ensure adherence to payer requirements and regulatory guidelines. Additionally, the position requires cross-functional collaboration with clinical, billing, and administrative teams, as well as external stakeholders, to streamline processes and enhance patient and provider experience.

Requirements

Two years of Prior Authorization and Eligibility experience Required

Nice To Haves

Associates Degree or Bachelor’s Degree preferred
Professional certification Preferred

Responsibilities

Reliable and punctual attendance is essential; expected to be at job as scheduled each day.
Communicate necessary information to others as appropriate.
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.
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.
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.
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.
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.
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.