Senior Manager-Business Operations

Medical University of South Carolina•Charleston, SC

3d•Onsite

About The Position

The Senior Manager of Preauthorization Services is responsible for the strategic oversight, operational management, and continuous improvement of all preauthorization and prior approval activities across the hospital or health system. This role ensures timely, accurate, and compliant insurance authorizations to support optimal reimbursement, reduce denials, and enhance patient access and satisfaction. The Senior Manager partners closely with clinical, access, coding, billing, and payer relations teams to align preauthorization processes with revenue cycle best practices and organizational goals.

Requirements

Bachelor's degree or equivalent education and/or relevant work experience
8 years progressive work experience
3 years management experience

Nice To Haves

Lean, Six Sigma

Responsibilities

Provide strategic direction and day-to-day leadership for all preauthorization services across inpatient, outpatient, and procedural areas.
Design, implement, and standardize authorization workflows to ensure efficiency, scalability, and compliance.
Establish departmental goals, KPIs, and performance benchmarks aligned with revenue cycle and organizational objectives.
Lead change initiatives to support new service lines, payer requirements, and organizational growth.
Ensure timely and accurate authorizations to minimize denials, delays in billing, and revenue leakage.
Analyze authorization-related denial trends and collaborate with denial management and appeals teams to drive corrective action.
Monitor financial performance metrics including authorization-related denial rates, clean claim rates, and impact to net revenue.
Support clean claims and timely billing through strong upstream authorization practices.
Directly manage managers, supervisors, and/or team leads within preauthorization services.
Recruit, develop, and retain a high-performing workforce through coaching, performance management, and succession planning.
Establish productivity standards and accountability measures while promoting employee engagement and professional growth.
Foster a culture of collaboration, service excellence, and continuous improvement.
Serve as the primary operational liaison with payers related to authorization requirements, escalations, and process improvements.
Partner with clinical leaders, physicians, patient access, scheduling, case management, and billing teams to align workflows.
Support payer meetings and contract discussions by providing data and operational insight related to authorization performance.
Communicate authorization requirements and changes clearly to internal stakeholders.
Ensure compliance with payer contracts, CMS regulations, and organizational policies.
Maintain current knowledge of medical necessity guidelines and evolving authorization requirements.
Lead quality assurance audits, root cause analyses, and corrective action plans.
Leverage data analytics, automation, and process improvement methodologies (Lean, Six Sigma) to enhance performance.