REFERRALS & PRIOR AUTHORIZATION MANAGER

Outsource Accelerator; Pasig; On-site; PHP 1,000,000 - 1,600,000; Full time

Job summary

Outsource Accelerator is seeking a PA&R Manager to oversee the offshore team’s daily operations and 72-hour SLA target. You will report to the US-based PA&R Owner, ensuring queue health, staffing, and documentation are maintained, with escalation processes for red or yellow queue states.

You will drive KPI ownership, QA, training, and continuous improvement across processes, including Intergy and Oracle EHR migrations, while coordinating Pacific-time clinic hours.

Qualifications

• 3+ years leading a healthcare revenue cycle or managed care ops team of 10+ staff with SLA accountability.
• Experience with referral coordination, prior auth, and PA in commercial/Medicare/Managed plans.
• KPI-driven management style with a track record of corrective actions.

Responsibilities

• Own daily operations and queue health for the offshore team.
• Manage staff scheduling, capacity, and backfill acrossPacific-time hours.
• Own KPI and SLA metrics; report weekly to US owner and lead monthly reviews.
• Lead onboarding, QA, and competency assessments for staff growth and quality.
• Enforce SOPs, document workflows, and surface payer/clinic issues with data.

Skills

Leadership

Healthcare revenue cycle

Staff scheduling

EHR systems

KPI & SLA management

Written English

Tools

Intergy

Oracle EHR migration

Job description

About the Role

This is a working leadership role. The PA&R Manager owns the daily operations of the offshore team end to end: queuehealth, service level attainment, staff scheduling and development, clinic and provider relationships, and continuousimprovement. You will report directly to the Clinical PA&R Owner (US-based) and beaccountable for the team hitting a 72-hour turnaround SLA KPI with a 24-hour goal.

What You Will Own

1. Day-to-day operations and queue health

• Open and run the daily 15-minute stand-up: WIP by lane, oldest task, staffing gaps, blockers.
• Monitor the Intergy task queue throughout the shift; redistribute work in real time when a lane falls behind.
• Ensure every STAT/P1 order is acknowledged within the same business day and escalated to the US-based PA&R
• Owner immediately; confirm a named handler is reachable for every Pacific-time clinic hour.
• Send a written end-of-shift handoff to the US owner each day covering STAT/P1 activity, stuck tasks, and itemsneeding a US-side decision.
• Own the team's documentation standard: every task note includes status, action taken, confirmation numbers,facility details, and next-action date.

2. Staff scheduling, capacity, and time off

• Build and maintain the team schedule, ensuring shift coverage aligns with Pacific-time clinic hours.
• Manage time-off requests, approvals, and backfill so queue capacity never falls below a safe level; plan around
• Philippine holidays well in advance.
• Track daily productivity per person and per lane; identify when the team needs flex hours or temporaryreallocation before a backlog forms.
• Coordinate with the staffing vendor on hiring timelines, onboarding, and backfill for attrition. The vendor SLAtargets a defined replacement window; you hold them to it.

3. KPI ownership and SLA accountability

• Own the team's scorecard (detail below) and report to the US PA&R Owner weekly; run a monthly business review with the staffing vendor's account lead.
• Diagnose the root cause when a metric misses: staff skill gap, process failure, clinic-side yield problem, or payer issue, and bring a corrective action with a timeline.
• Maintain a real-time queue health view: green (WIP 1 day of inflow), yellow (1–2 days), red (>3 days or any STAT miss); trigger the escalation ladder the moment the queue hits yellow.
• Track and report first-pass yield by clinic and provider; flag low-yield clinics to the US owner for targetededucation.

4. Team development, training, and quality

• Lead structured onboarding for new staff using lane-certification curriculum (Foundations Systems Wave 1 triage/referral-only Wave 2 auth/med PA/pending Wave 3 exceptions).
• Conduct QA audits: 100% review during a new employee's first 50 tasks in each lane, dropping to a steady-state sample once certified; monthly calibration sessions with all staff.
• Administer 30/60/90-day lane certifications and the 6- and 12-month competency assessments; maintain recordsfor each staff member.
• Coach staff on payer rules, clinical documentation requirements, and return-to clinic standards; escalated persistent gaps as training needs to the US owner.
• Identify candidates within the team for the exceptions lane and senior specialist progression.

5. Process adherence and continuous improvement

• Enforce SOPs without exception: one task per order, real-time documentation, templated return-to-clinic notes
• with exact missing items, no work outside the Intergy queue.
• Surface recurring payer, clinic, or system issues to the US owner with supporting data, not just anecdotes.
• Participate in SOP update reviews; flag steps that do not match what staff encounter in practice.
• Support Oracle EHR migration activities as directed; ensure the team's workflow documentation stays currentthrough system changes.

What You Need to Bring

Required

• 3+ years leading a healthcare revenue cycle or managed care operations team of 10 or more staff, with direct accountability for service level attainment.
• Demonstrated referral and prior authorization experience: working knowledge of referral coordination, medical prior auth, and medication PA (including step therapy), across commercial PPO/HMO, Medicare/Medicare
• Advantage, Medicaid/managed Medicaid, and government program plans (TriCare, VA Community Care).
• KPI-driven management style: you have owned a scorecard, diagnosed misses, and delivered corrective actions with measurable results — bring examples.
• Scheduling and capacity management: experience building team schedules across time zones, managing leave coverage, and adjusting real-time allocation when volume spikes.
• EHR task queue fluency: comfort working in a structured task-based EHR system (Intergy by Greenway experience is a strong plus; comparable systems are acceptable).
• Strong written English: all documentation, patient and provider notes, and US-stakeholder communication is in written English.

Working Conditions:

• can workOnsite

• Availability during Pacific-time business hours: the team must maintain live coverage for STAT escalations during Pacific clinic hours (approximately 8 AM–5 PM PT); shift structure is negotiable but coverage is not.