Prior Authorization Manager

Job Summary

Managing complex authorization issues, the full-time Prior Authorization Manager will coordinate with providers, patients, and payors while developing processes and training for offshore team members in a remote setting.

Key responsibilities

• Resolve complex authorization issues by collaborating with providers, patients, and payors
• Act as the in-house expert for prior authorizations and pre-certification requests for designated regions or payors
• Identify workflow bottlenecks and inefficiencies while owning Prior Authorization outcomes and KPIs

Required qualifications

• 5+ years of experience in ABA intake with a focus on Prior Authorizations or Insurance Certification
• Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
• Ability to read and interpret complex clinical documents and EHR data related to prior authorization workflows
• Proven track record of effective communication with diverse stakeholders, including parents and clinicians
• Demonstrated problem-solving skills and comfort with ambiguity in decision-making