Prior Authorization Representative Jobs (NOW HIRING)

PRIOR AUTHORIZATION MANAGER

Texas Institute for Neurological Disorders / US Neurology Associates
Department: Revenue Cycle / Operations
Schedule: Full-Time, Monday–Friday
Location: On-Site, Plano / Frisco

The Prior Authorization Manager is responsible for bringing the prior authorization function in-house and building a high-performing team that supports a multi-site outpatient neurology practice. This leader will assess and redesign current outsourced workflows, establish standardized processes and service levels, and oversee end-to-end authorization activity for physician visits, diagnostic testing, procedures, infusion therapies, and ancillary services.

This is a hands-on, build-oriented leadership role. The Manager must bring deep prior authorization expertise, strong payer knowledge, and meaningful experience leading teams in complex, high-volume specialty care environments. Neurology and infusion authorization experience are critical to success.

KEY RESPONSIBILITIES

Function Buildout & Team Leadership

• Lead the transition of prior authorization work from outsourced and offshore resources to an internal USNA team.
• Assess current-state workflows, define the future-state operating model, and implement standardized policies, procedures, escalation paths, and service-level expectations.
• Build, train, coach, and manage a team of prior authorization representatives; establish clear productivity, quality, and turnaround-time expectations.
• Develop staffing plans and workload allocation models that support growth across multiple clinic locations and service lines.
• Create a culture of accountability, urgency, accuracy, and proactive communication.

Prior Authorization Operations

• Oversee end-to-end prior authorization for office visits, MRIs, EMG, EEG, sleep studies, infusions, Botox and other injections, and additional diagnostic and ancillary services.
• Ensure authorizations are initiated, tracked, escalated, renewed, and closed within payer-required and internal timelines.
• Own denial and appeal workflows, including root-cause analysis, clinical documentation coordination, peer-to-peer support, and trend reporting.
• Protect patient access and clinic schedules by ensuring required authorizations are verified before services are delivered.
• Serve as the escalation point for urgent, complex, or high-value authorization cases, particularly infusion therapies.

Payer, Provider & Cross-Functional Partnership

• Maintain strong working knowledge of commercial, Medicare, Medicare Advantage, Medicaid managed care, and specialty payer requirements.
• Partner closely with physicians, clinical teams, scheduling, front desk, revenue cycle, and operations leadership to resolve authorization barriers.
• Serve as the internal subject matter expert on payer requirements, medical necessity documentation, and authorization best practices.
• Build productive relationships with payer representatives and escalation teams to improve approval rates and turnaround times.

Reporting & Continuous Improvement

• Establish dashboards and reporting for queue volume, turnaround time, approval and denial rates, appeal outcomes, productivity, and aging.
• Use data to identify bottlenecks, payer trends, staffing needs, and opportunities to improve patient access and revenue capture.
• Maintain complete and accurate authorization documentation in eClinicalWorks and payer portals.
• Ensure compliance with HIPAA, payer rules, and organizational policies.

QUALIFICATIONS

Required

• Minimum 7 years of prior authorization experience in an outpatient specialty healthcare setting.
• Minimum 5 years of direct team leadership or management experience in prior authorization, patient access, or a closely related function.
• Demonstrated experience building, restructuring, or insourcing a prior authorization function.
• Deep experience with high-volume, complex authorizations and payer escalation processes.
• Strong knowledge of commercial, Medicare, Medicare Advantage, and Medicaid managed care requirements.
• Experience with eClinicalWorks or a comparable EMR/practice management platform and major payer portals.
• Strong operational judgment, analytical skills, and ability to lead through ambiguity in a growth-stage environment.

Preferred

• Prior authorization leadership experience in neurology and infusion services.
• Experience with EMG, EEG, MRI, Botox, sleep studies, and other neurology-related services.
• Experience supporting a multi-site specialty practice in the Dallas-Fort Worth market.
• CPAR, CRCR, or comparable patient access/revenue cycle certification.

SUCCESS FACTORS

• Successful transition of prior authorization operations in-house with minimal disruption to patients and clinics.
• Improved authorization turnaround time, approval rate, and schedule clearance.
• Clear team structure, standardized workflows, and reliable performance reporting.
• Reduced authorization-related denials, cancellations, and lost revenue.

COMPENSATION & BENEFITS

Salary Range: Commensurate with experience
Benefits: Medical, dental, vision, PTO, and 401(k)
Employment Type: Full-Time

Texas Institute for Neurological Disorders / US Neurology Associates is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.