Note: The job is a remote job and is open to candidates in USA. Prompt Health is a healthcare technology company focused on revenue cycle management and patient access operations. The Manager, Benefit Verification & Authorization Operations leads the Benefit Verification and Authorization teams, overseeing performance, quality, service levels, escalations, and operational efficiency. The role also drives process improvement, team-lead development, training, and collaboration with other RCM functions to prevent denials and reimbursement delays.
Responsibilities
- 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
- 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
- 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
- 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
- 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
Skills
- 5+ years of experience in healthcare revenue cycle management, patient access, Benefit Verification, Prior Authorization, or related 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
- 2+ years of people management experience, preferably within healthcare operations
Company Overview