Role OverviewThe client is seeking a
Prior Authorizations Lead to design, manage, and scale their prior authorization function. This role is ideal for an operator who excels at bringing structure to complexity, driving efficiency, and building systems that scale.
The Prior Authorizations Lead will own the full authorization lifecycle-from intake and submission to payer follow-up and resolution-ensuring fast turnaround times and exceptional provider experience. The role requires a strategic, hands-on leader who can define workflows, streamline operations, and partner cross-functionally to leverage automation.
Key Responsibilities- Lead the end-to-end prior authorization process, including verification, documentation, submission, and payer follow-up.
- Build, optimize, and scale workflows to reduce turnaround times and increase authorization approval rates across multiple specialties.
- Partner with Product and Engineering to identify automation opportunities and develop tools that reduce manual work.
- Collaborate with RCM and Operations teams to ensure seamless handoffs across authorizations, billing, and care coordination.
- Develop and manage KPIs to track performance, identify operational bottlenecks, and drive continuous improvement.
- Train and manage internal team members and/or vendor partners to ensure consistent execution and compliance with payer guidelines.
- Maintain up-to-date knowledge of payer policies, clinical criteria, and regulatory changes that impact authorization processes.
- Build SOPs, playbooks, and documentation to support scaling into new states, payers, and clinical domains.
Qualifications- Bachelor's degree required
- 5-8 years of experience in healthcare operations, prior authorization management, or related RCM roles
- Deep understanding of payer requirements, medical necessity standards, and authorization workflows
- Proven ability to lead cross-functional initiatives and manage high-volume operational processes
- Analytical, systems-oriented thinker with a track record of improving turnaround times and accuracy
- Experience with automation tools or EMR/EHR integrations is a plus
- Ability to work fully in-person, 5 days per week, in San Francisco or New York
CompensationEstimated Salary: $100,000-$140,000
Total compensation may also include stock options. Final compensation will depend on experience, qualifications, and other relevant factors.
