Manager - Prior Authorization ( Mumbai)

ECLAT Health Solutions; Mumbai; On-site; INR 2,500,000 - 3,500,000; Full time

Job summary

ECLAT Health Solutions in Mumbai seeks a Manager - Prior Authorization to lead end-to-end authorization operations across physician billing. The role focuses on optimizing workflows, ensuring timely approvals, and maintaining compliance with payer and client requirements.

You will manage a large team, monitor KPIs, mentor staff, and collaborate with providers and payers to resolve authorization issues while delivering accurate performance reports and dashboards.

Qualifications

• 10+ years in healthcare prior authorization operations.
• Experience leading large teams (100+ specialists) preferred.
• Strong knowledge of CPT, ICD-10, HCPCS and payer guidelines.
• Experience with Medicare/Medicaid and commercial payers.

Responsibilities

• Lead and manage a team of Prior Authorization Specialists handling multiple physician specialties
• Oversee end-to-end Prior Authorization processes, including eligibility verification, authorization submissions, follow-ups, and approvals
• Ensure timely submission and tracking of authorization requests to prevent delays in patient care and claim reimbursement
• Manage escalations related to authorization denials, medical necessity requirements, and payer-specific guidelines
• Monitor team performance against KPIs, SLAs, quality metrics, and productivity targets
• Identify process gaps and implement operational improvements to enhance efficiency and turnaround times
• Provide floor support, coaching, training, and mentoring to team members
• Ensure adherence to client requirements, payer policies, HIPAA, and compliance standards
• Collaborate with providers, clinical teams, and payer representatives to resolve authorization-related issues
• Prepare and present daily, weekly, and monthly performance reports and operational dashboards

Skills

Prior Authorization

Team management

HIPAA compliance

Analytical reporting

Job description

Job Title: Manager - Prior Authorization

Experience: 10+ Years (Minimum 1 Year as Operations Manager)

Job Summary

We are seeking an experienced Prior Authorization Manager with strong expertise in managing end-to-end Prior Authorization operations across Physician Billing specialties. The ideal candidate will lead large teams, ensure timely authorization approvals, optimize workflows, and drive operational excellence while maintaining compliance with payer and client requirements.

Key Responsibilities

• Lead and manage a team of Prior Authorization Specialists handling multiple physician specialties
• Oversee end-to-end Prior Authorization processes, including eligibility verification, authorization submissions, follow-ups, and approvals
• Ensure timely submission and tracking of authorization requests to prevent delays in patient care and claim reimbursement
• Manage escalations related to authorization denials, medical necessity requirements, and payer-specific guidelines
• Monitor team performance against KPIs, SLAs, quality metrics, and productivity targets
• Identify process gaps and implement operational improvements to enhance efficiency and turnaround times
• Provide floor support, coaching, training, and mentoring to team members
• Ensure adherence to client requirements, payer policies, HIPAA, and compliance standards
• Collaborate with providers, clinical teams, and payer representatives to resolve authorization-related issues
• Prepare and present daily, weekly, and monthly performance reports and operational dashboards

Required Skills & Expertise

• Strong domain knowledge in Prior Authorization for Physician Billing
• Hands-on experience with authorization submissions, follow-ups, and denial resolution
• Good understanding of CPT, ICD-10, HCPCS codes, modifiers, and medical necessity criteria
• Experience working with Medicare, Medicaid, and Commercial payers
• Strong knowledge of payer authorization requirements, turnaround times, and escalation processes
• Ability to analyze authorization trends and implement corrective actions
• Excellent team management, stakeholder engagement, and client communication skills
• Strong analytical, reporting, and problem-solving abilities

Preferred Qualifications

• Prior experience managing a team of 100+ Prior Authorization Specialists
• Exposure to client interactions, business reviews, and escalation management
• Experience with multiple specialties such as Radiology, Oncology, Cardiology, Orthopedics, Pain Management, and Surgery
• Knowledge of Revenue Cycle Management (RCM) processes and payer portals

Notice Period: Immediate to 30 Days Preferred.