Manager - Prior authorization (US Healthcare)

Talentq Solutions; Hyderabad; In loco; INR 2.500.000 - 4.500.000; Tempo pieno

Descrizione del lavoro

Talentq Solutions in Hyderabad, India seeks a results-driven Pre-Authorization Manager to oversee end-to-end Prior Authorization workflows for a leading US healthcare client.

You will lead a team of Assistant Managers and Team Leaders, drive accuracy, compliance, and KPI achievement, while staying current with CMS guidelines, CPT/ICD-10 coding changes, and HIPAA requirements. This role requires 10–14 years in Prior Authorization and related processes, with hands-on EHR experience (Epic).

Competenze

• 10–14 years of experience in Prior Authorization, Eligibility Verification, Insurance Verification and related US healthcare processes.
• Strong analytical and problem-solving skills with attention to detail.
• Ability to interpret complex operational data and identify improvement areas.

Mansioni

• Operational Oversight: Manage end-to-end Prior Authorization workflows from request to approval.
• Team Management: Lead and mentor a team of Assistant Managers and Team Leaders; drive KPIs.
• Compliance: Stay updated with CMS guidelines, CPT/ICD-10 changes, and HIPAA standards.
• Denial Strategy: Analyze trends and implement root-cause analysis to reduce denials.

Conoscenze

US healthcare regulations

Analytical skills

Team leadership

Interpreting operational data

Strumenti

Epic Systems

Descrizione del lavoro

About the Role:

We are looking for a result-oriented Pre-Authorization Manager for a leading US Healthcare company

Key Responsibilities:

Operational Oversight

• Manage end-to-end Prior Authorization workflows, from initial request to final approval.
• Ensure timely processing of authorizations with high accuracy and compliance standards.

Team Management

• Lead and mentor a team of Assistant Managers and Team Leaders.
• Drive operational performance metrics and KPIs.
• Conduct regular performance reviews and process improvement initiatives.

Compliance

• Stay updated with CMS guidelines, CPT/ICD-10 coding changes, and payer-specific medical policies.
• Ensure adherence to HIPAA and other US healthcare regulatory standards.

Denial Strategy

• Analyze trends related to Authorization Required denials.
• Implement proactive root-cause analysis and preventive action plans to reduce denials.

Desired Candidate Profile

• 10 to 14 years of experience in:
• Prior Authorization
• Eligibility Verification
• Insurance Verification
• Related US Healthcare processes

• Strong understanding of US healthcare regulations and industry standards, including HIPAA.

• Excellent analytical and problem-solving skills.

• Ability to interpret complex operational data and identify improvement areas.

• Hands-on experience with Electronic Health Record (EHR) systems such as Epic Systems or similar platforms.

Designation Criteria

Candidates should currently be:

• In a Deputy Manager role for at least 1 year,
  OR
• In an Assistant Manager role for 2+ years