Manager, Benefit Verification & Authorization Operations

Job description

Manager, Benefit Verification & Authorization Operations Salary Range: $80k-$90k The Role The Manager, Benefit Verification & Authorization Operations is responsible for leading Prompt’s Benefit Verification and Authorization teams, ensuring accurate, timely, and consistent execution across our RCM clients. This role directly manages the Benefit Verification and Authorization Team Leads and is accountable for overall team performance, quality, service levels, and operational efficiency. The Manager will use data to identify performance gaps, resolve escalations, develop team leaders, and continuously improve processes that support patient access and prevent downstream billing and reimbursement issues. Key Responsibilities TEAM LEADERSHIP & OPERATIONS - Lead the Benefit Verification and Authorization functions, ensuring teams consistently meet quality, productivity, and turnaround-time expectations. - Directly manage and develop the Benefit Verification and Authorization Team Leads. - Ensure workloads, staffing, and priorities are aligned with client volumes and business needs. - Establish clear expectations and accountability across both teams. - Support Team Leads with complex operational, payer, client, and employee escalations. - Build a high-performing culture centered on accuracy, urgency, accountability, and ownership. PERFORMANCE & QUALITY - Own key performance metrics and SLAs across Benefit Verification and Authorization. - Monitor verification accuracy, turnaround times, authorization approval rates, pending authorizations, backlog, productivity, and authorization-related denials. - Use reporting and dashboards to identify performance gaps, payer trends, and operational risks. - Partner with Team Leads to implement corrective action plans when performance falls below expectations. - Ensure consistent quality assurance and auditing processes are in place across both teams. OPERATIONAL OVERSIGHT & ESCALATIONS - Ensure patients have accurate benefit information and required authorizations are identified and managed appropriately. - Ensure teams proactively identify missing, pending, expiring, or exhausted authorizations before they impact scheduled visits or reimbursement. - Serve as the management-level escalation point for complex payer, client, and workflow issues. - Analyze recurring verification and authorization issues to identify root causes and prevent future occurrences. - Partner with Billing, AR, and other RCM teams to reduce downstream denials and reimbursement delays. PROCESS IMPROVEMENT - Identify opportunities to improve Benefit Verification and Authorization workflows, accuracy, and scalability. - Standardize processes and best practices across teams and clients. - Identify opportunities for automation and system improvements that reduce manual work. - Partner with RCM leadership, Product, and BI on reporting, workflow, and system enhancements. - Ensure process and system changes are effectively communicated, implemented, and monitored. TRAINING & TEAM DEVELOPMENT - Ensure Team Leads have effective onboarding, training, and ongoing coaching programs in place. - Develop Team Leads into strong operational leaders who can independently manage daily team performance. - Identify knowledge and skill gaps and ensure appropriate training is provided. - Maintain clear SOPs, payer resources, and workflow documentation across both functions. Minimum Requirements - 5+ years of experience in healthcare revenue cycle management, patient access, Benefit Verification, Prior Authorization, or related healthcare operations. - 2+ years of people management experience, preferably within healthcare operations. - Strong knowledge of insurance eligibility, benefits, prior authorization, and payer requirements. - Experience managing teams against productivity, quality, and turnaround-time expectations. - Strong analytical and problem-solving skills with the ability to identify root causes and implement solutions. - Demonstrated ability to manage complex operational and payer escalations. - Strong leadership, coaching, and performance management skills. - Experience improving and standardizing operational processes. - Experience with practice management systems, payer portals, healthcare technology platforms, and reporting tools. - Ability to operate independently and effectively manage competing priorities in a fast-paced environment. HIPAA REQUIREMENTS All associates are required to comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations regarding the protection of patient health information. This includes adherence to the organization's Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. The specific statements provided in this job description are not exhaustive and may be subject to change based on evolving business needs. Associates may be required to perform additional duties as assigned.