Prior Authorization Lead
Core
Design, manage, and scale end-to-end prior authorization operations to ensure timely, accurate approvals for clinician partners across multiple specialties.
Role type
Senior operational lead for prior authorization
Builds
Scalable authorization workflows and automation tools for private practice providers
Domain
Healthcare operations / Revenue Cycle Management (RCM)
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
End-to-end prior authorization process management, workflow optimization, cross-functional partnership, KPI development and tracking, team/vendor management, payer requirements knowledge, regulatory compliance, SOP creation
Preferred skills
Automation tool experience, EMR/EHR integrations
Technologies
EMR/EHR systems
Responsibilities
Lead the end-to-end prior authorization process including verification, documentation, submission, and payer follow-up; Build and optimize workflows to minimize turnaround times and maximize approval rates; Partner with Product and Engineering to identify automation opportunities; Collaborate with RCM and Operations teams to ensure clean handoffs; Develop and track KPIs to monitor performance and identify bottlenecks; Train and manage a growing team or vendor partners; Maintain up-to-date knowledge of payer requirements and regulatory changes; Build documentation, playbooks, and SOPs to support scaling
Seniority
Senior, hands-on operator
