Healthcare RCM Manager, Authorization Operations

Our RCM Team is growing and we're hiring a Manager, Authorization Operations to join our team! This role is fully remote and we're willing to consider candidates based on location.

The Manager, Authorization Operations is responsible for leading and overseeing authorization operations that support timely patient care, preserve provider utilization, minimize preventable denials, and protect revenue integrity across the organization. This role oversees authorization workflows for scheduled services, procedures, specialty services, and high-priority patient encounters while ensuring compliance with payer requirements, medical necessity guidelines, and operational turnaround expectations. This position partners closely with clinical, operational, scheduling, revenue cycle, and offshore teams to drive efficient authorization workflows, timely escalation management, standardized operating procedures, and continuous process improvement initiatives. The Manager is responsible for supporting operational performance through strong leadership, workflow optimization, accountability, and proactive issue resolution. This role requires a highly motivated operational leader with strong knowledge of authorization management, payer requirements, medical necessity review, utilization impact, and healthcare operations. This position is expected to operate with a high degree of ownership, initiative, accountability, and operational leadership. Duties and Responsibilities

• Lead and oversee daily authorization operations across multiple markets, practices, and service lines to ensure timely and accurate authorization processing.
• Partner collaboratively with offshore operational teams to support workflow coordination, turnaround times, escalation management, and authorization quality outcomes.
• Ensure authorization activities are completed accurately, timely, and in compliance with payer requirements, medical necessity guidelines, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and clinical documentation standards.
• Develop and maintain standardized authorization workflows, escalation pathways, urgency definitions, and operational procedures.
• Establish operational standards for STAT, urgent, ASAP, and routine authorization requests to support timely patient care, preserve provider utilization, and minimize scheduling disruptions.
• Monitor aging authorization requests and proactively escalate unresolved cases to prevent delays, cancellations, lost procedural volume, and avoidable revenue leakage.
• Partner closely with scheduling, clinical, and operational teams to resolve pending, delayed, denied, or escalated authorizations that may impact patient care, provider utilization, or scheduling operations.
• Understand key nephrology revenue drivers and prioritize authorization workflows based on patient acuity, operational urgency, provider schedules, and financial impact.
• Utilize athenaOne, payer portals, reporting tools, and operational dashboards to monitor authorization status, productivity, turnaround times, denial trends, and workflow performance.
• Identify process improvement and automation opportunities to improve turnaround times, reduce manual work, improve quality outcomes, and support scalable operational growth.
• Establish, monitor, and report on operational KPIs including authorization turnaround time, denial rates, aging inventory, escalation trends, productivity metrics, and utilization impact.
• Assist with staff development, workflow education, operational training, and continuous improvement initiatives to support team performance and operational consistency.
• Perform other duties and responsibilities as required, assigned, or requested.

Functional and Technical Competencies

• Strong knowledge of payer authorization requirements, medical necessity guidelines, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and healthcare operational workflows.
• Demonstrated understanding of the operational and financial impact of authorization delays, denials, and scheduling disruptions on provider utilization and revenue cycle performance.
• Strong understanding of authorization escalation management, urgency prioritization, and denial prevention strategies.
• Experience utilizing athenaOne, payer portals, reporting tools, and operational dashboards to manage authorization workflows and operational performance.
• Ability to develop standardized workflows, operational procedures, and escalation protocols.
• Strong analytical, organizational, communication, problem-solving, and operational leadership skills.
• Ability to operate effectively in fast-paced, evolving operational environments with a high degree of accountability, initiative, and ownership.

Job Requirements

• Bachelor’s degree preferred or equivalent combination of education and relevant healthcare operations experience.
• Minimum of 5 years of progressive healthcare revenue cycle or authorization experience.
• Minimum of 2 years of leadership or supervisory experience within healthcare operations or revenue cycle management.
• Strong experience managing authorization operations within physician practice, specialty care, or large-scale healthcare environments.
• Experience collaborating with offshore teams and supporting large-scale operational workflows.
• Advanced experience using athenaOne/athenahealth.
• Experience with insurance verification, authorization escalation management, denial prevention, and workflow optimization.
• Experience within nephrology, dialysis, ESRD, or specialty physician practice environments strongly preferred.
• Experience with Epic, AdvancedMD, and/or Veradigm preferred.
• Experience leading operational process improvement initiatives preferred.
• Lean Six Sigma, PMP, CRCR, or related operational certifications preferred.
• Demonstrated desire and capability to grow into broader operational leadership responsibilities.

The Company is committed to the principles of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race, color, national origin, ancestry, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), physical or mental disability, genetic information (including testing and characteristics), veteran status, uniformed servicemember status, or any other status protected by federal, state, or local laws. The company is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment

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