Manager - RCM Prior Authorization
- INFINX
- 8 - 13 years
- Mumbai
- 25 days ago
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Job Description
Manager Prior Authorization)
Role Summary:
We are launching a dedicated Tiger Team focused on rapid turnaround of underperforming Prior Authorization (PA) accounts. This 5-member strike team will diagnose deep-rooted operational challenges, realign delivery with client expectations, and stabilize PA operations. The role demands strong leadership, cross-functional collaboration, and a hands-on approach to clinical and administrative PA workflows.
Each member of this elite team will bring functional depth and the ability to drive results under pressure in a client-facing, metric-intensive environment.
Primary Objectives:
- Rescue At-Risk PA Accounts
- Deep-dive into failing metricsTAT, approval rate, complianceand implement recovery plans.
- Engage with clients and internal stakeholders to rebuild confidence and credibility.
- Improve Approval Rates and Reduce TAT
- Address high denial volumes and slow payer responses through workflow, documentation, and escalation enhancements.
- Fix Process Breakdowns
- Re-engineer PA intake, clinical review, submission, and follow-up stages.
- Introduce SOPs and best practices for consistent performance.
- Align Client and Internal KPIs
- Ensure operational definitions match client expectations (e.g., how approvals, denials, or escalations are counted).
- Drive towards measurable, client-signed targets.
- Build Sustainable Delivery Models
- Document recovery playbooks and mentor BAU teams to maintain improved performance post-handover.
- Recommend automation or tech augmentation where feasible.
Roles and Functional Skillset Requirements:
Role Focus
Skills & Expectations
PA Operations Turnaround Lead
Owns project plans for account recovery, stakeholder management, and delivery execution. Well-versed in end-to-end PA.
Clinical Reviewer / SME
Reviews medical necessity, coding, and documentation. Guides the team on clinical alignment with payer policies.
Payer Strategy Specialist
Builds rapid engagement with payers, improves portal usage, handles escalations, and understands multi-payer behavior.
Quality & Training Manager
Identifies skill gaps, updates SOPs, runs booster training sessions to lift performance quickly.
MIS & Performance Analyst
Builds visibility through dashboards and reporting. Tracks metrics like TAT, approval %, FTR, denial trends.
General Competencies (for all roles):
- High accountability: Operates with urgency and clear ownership
- Hands-on delivery focus: Comfortable working in the trenches to turn around struggling operations
- Strong in client/stakeholder communication: Able to reset expectations, drive alignment
- Problem-solving under pressure: Manages ambiguity and competing priorities
- Clinical + Operational fluency: Understanding of U.S. healthcare PA workflows and payer landscape
Qualifications:
- Bachelors degree required; Clinical background (RN, LPN, BPT, etc.) preferred for Clinical SME roles
- 610 years of experience in healthcare RCM, with at least 3 in Prior Authorization
- Proven experience in client-facing roles and performance improvement initiatives
- Familiarity with EMRs (Epic, Cerner, Allscripts), payer portals, and PA workflow tools
- Six Sigma/Lean or equivalent process improvement exposure is a plus
Job Classification
Industry: BPM / BPOFunctional Area / Department: Customer Success, Service & OperationsRole Category: OperationsRole: Operations ManagerEmployement Type: Full timeContact Details:
Company: INFINXLocation(s): Mumbai
Keyskills: US Healthcare RCM
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INFINX
About Infinx:Infinx provides revenue cycle management (RCM) solutions for healthcare practices. Combining the strength of our cloud-based RCM platforms with our expert team of certified medical coders and billing specialists, we deliver solutions that focus on increasing revenue and improving cash...
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