Prior Authorization Unit Supervisor

The Prior Authorization Manager oversees the end-to-end authorization workflow, ensuring that service requests submitted to Medicaid, Medicare, and commercial payers meet the criteria for approval and are processed within required timelines.

Requirements

• Supervise daily operations of the prior authorization and intake team
• Maintain updated knowledge of payer-specific authorization requirements and clinical documentation standards
• Review and approve initial and continuing authorizations for submission
• Collaborate with providers, case managers, and clinical documentation teams to obtain and verify required records
• Ensure all requests are submitted accurately and within deadlines to avoid care delays or denied claims
• Guarantee that all medical and behavioral health clients are authorized no later than three business days prior to service
• Monitor and manage team productivity metrics (e.g., turnaround time, approval rates, rework rate)
• Develop internal workflows and SOPs to standardize intake and authorization processing
• Train and cross-train team members on systems, policy changes, and payer updates
• Coordinate appeal and reconsideration submissions for denied authorizations
• Maintain accurate and auditable logs of authorizations, expiration dates, and renewal status
• Serve as liaison between the billing department and clinical teams to ensure pre-authorization alignment with reimbursement expectations
• Provide weekly reporting to the Director of Operations on authorization volume, turnaround times, and outcomes