Manager - Prior Authorization

3 weeks ago

Hyderabad, India Primera Medical Technologies Full time

The Prior Authorization Manager is responsible for overseeing the daily operations of the prior authorization department. This role involves leading a team to ensure all required prior authorizations are obtained accurately and in a timely manner for patient services, medications, and procedures. The manager will develop and implement efficient workflows, monitor key performance indicators, ensure compliance with all payer and regulatory requirements, and serve as a key resource for staff and clinical teams. The ultimate goal is to minimize claim denials, reduce delays in patient care, and optimize the revenue cycle.

Key Responsibilities:

Leadership and Team Management:

  • Lead, train, and mentor a team of prior authorization specialists.
  • Manage daily workflow, delegate tasks, and ensure productivity goals are met.
  • Conduct performance reviews, provide constructive feedback, and identify opportunities for professional development.

Operational Oversight:

  • Oversee the end-to-end prior authorization process for all requested services.
  • Develop and implement standard operating procedures (SOPs) to streamline workflows and improve efficiency.
  • Monitor and analyze key performance indicators (KPIs) such as approval rates, turnaround times, and denial trends.

Compliance and Quality Assurance:

  • Ensure all prior authorization activities adhere to federal, state, and payer-specific regulations.
  • Conduct regular audits of submitted authorizations to maintain a high level of accuracy and quality.
  • Stay current with changes in payer policies, medical necessity criteria, and coding guidelines.

Communication and Collaboration:

  • Serve as the primary point of contact for clinical staff and providers regarding prior authorization requirements.
  • Collaborate with the billing, coding, and patient financial services departments to resolve complex issues and prevent future denials.
  • Communicate with insurance companies and third-party payers to appeal denied authorizations.

Desired Candidate:

  • A minimum of 10 years of experience in prior authorization, medical billing, or revenue cycle management.
  • At least 2-3 years of experience in a leadership or supervisory role.
  • Prior Authorization Expertise: In-depth knowledge of prior authorization processes for a wide range of medical services and specialties.
  • Strong understanding of insurance and third-party payer policies, especially those from major health plans.
  • Experience with electronic health records (EHR) systems, prior authorization software, and Microsoft Office Suite.
  • Familiarity with HIPAA regulations and other healthcare compliance standards.
  • Excellent leadership, communication, and interpersonal skills.
  • Strong analytical skills to interpret data, identify trends, and make informed decisions.
  • Proven ability to resolve complex issues and manage competing priorities effectively.

Relevant Experience candidate can approach us on /

Regards,

Ramesh Arravalli

Senior Lead - Human Resources.

Primera Medical Technologies.

  • Manager - Prior Authorization

    7 days ago

    Hyderabad, Telangana, India Primera Medical Technologies Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    The Prior Authorization Manager is responsible for overseeing the daily operations of the prior authorization department. This role involves leading a team to ensure all required prior authorizations are obtained accurately and in a timely manner for patient services, medications, and procedures. The manager will develop and implement efficient workflows,...

  • Prior Authorization Team Lead

    4 weeks ago

    Hyderabad, India Staffingly, Inc Full time

    Job Description Job Title: Prior Authorization Team Lead Location: Kondapur, Hyderabad - ONSITE Shift Timing: U.S. Time Zone - Indian night shifts Department: Revenue Cycle / Prior Authorization We appreciate the value of your time as well as ours, so please review the entire job description and apply only if you are interested. At Staffingly, Inc., we...

  • MRI and CT Prior Authorization Specialist

    3 weeks ago

    Hyderabad, India Prove It Catalysts Full time

    *** Looking for IMMEDIATE JOINER *** Job Description: We are seeking a dedicated MRI and CT Prior Authorization Specialist to join our Radiology Services team. This role is critical in ensuring prior authorizations for MRI and CT scans are obtained efficiently while maintaining close communication with physicians to secure scripts, medical records, and...

  • MRI and CT Prior Authorization Specialist

    1 week ago

    Hyderabad, Telangana, India Prove It Catalysts Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    *** Looking for IMMEDIATE JOINER ***Job Description:We are seeking a dedicated MRI and CT Prior Authorization Specialist to join our Radiology Services team. This role is critical in ensuring prior authorizations for MRI and CT scans are obtained efficiently while maintaining close communication with physicians to secure scripts, medical records, and...

  • Prior Authorization

    3 weeks ago

    Hyderabad, India INTIGNIZ Solutions Pvt. Ltd. Full time

    We're Hiring – Pre Authorization| US Healthcare (Provider Side) Location: Hyderabad (Work from Office) Shift: Night Shift (2-way cab provided) Salary: Up to 5.5 LPA Completely in Voice Process Notice Period: Immediate Experience Required: 1–3 Years RCM / Denial Management Interview Process: Online Assessment → F2F Manager Round If interested,...

  • Prior Authorization

    5 days ago

    Hyderabad, Telangana, India INTIGNIZ Solutions Pvt. Ltd. Full time ₹ 5,50,000 per year

    We're Hiring – Pre Authorization| US Healthcare (Provider Side) Location: Hyderabad (Work from Office) Shift: Night Shift (2-way cab provided) Salary: Up to 5.5 LPACompletely in Voice Process Notice Period: ImmediateExperience Required: 1–3 Years RCM / Denial ManagementInterview Process: Online Assessment → F2F Manager Round If interested, share your...

  • Trainer and Lead Delivery-Clinical Prior Authorization

    4 weeks ago

    Hyderabad, India TalentQ Solutions Full time

    Job Description Description The Trainer and Lead Delivery-Clinical Prior Authorization will be responsible for training staff on clinical prior authorization processes and ensuring that all training programs are effectively delivered. This role requires a strong understanding of healthcare regulations, excellent communication skills, and the ability to...

  • is Hiring For SR. Prior Authorization Role

    3 days ago

    Hyderabad, Telangana, India Sutherland Full time ₹ 6,00,000 - ₹ 15,00,000 per year

    Role & responsibilitiesPrior Authorization ManagementInitiate and submit prior authorization requests for medical services, diagnostic procedures, and medications.Review and interpret payer guidelines to ensure proper documentation is provided.Track and monitor status of submitted authorizations and follow up with insurance payers as needed.Preferred...

  • Executive/SR Executive/QCA-Prior Authorization

    3 weeks ago

    Hyderabad, India Omega Healthcare Full time

    Location Hyderabad & work from office only Job highlights Minimum 1+ years' experience in Pre-Authorization and good understanding of medical terminology Obtain prior authorizations and referrals from insurance companies, monitor and update orders, provide clinical information for authorizations Job description **Please Ignore if you have experience into...

  • Executive/SR Executive/QCA-Prior Authorization

    2 weeks ago

    Hyderabad, Telangana, India Omega Healthcare Full time ₹ 2,00,000 - ₹ 6,00,000 per year

    Location Hyderabad & work from office onlyJob highlightsMinimum 1+ years' experience in Pre-Authorization and good understanding of medical terminologyObtain prior authorizations and referrals from insurance companies, monitor and update orders, provide clinical information for authorizationsJob description**Please Ignore if you have experience into NON...