EDUCATION (must be required for position), LICENSE, CERTIFICATION and EXPERIENCE: 1. Education: Associates Degree or Bachelor's Degree preferred 2. Licenses: No professional license required .. Certifications: Professional certification Preferred 4. Experience: Two years of Prior Authorization and Eligibility experience Required REQUIRED SCREENINGS: - Drug Screen - Physical Assessment - Tuberculosis screen - Background check (Criminal, Civil, Educational, Previous Employment, etc.) - Driver Record screen (positions requiring on-the-job driving) ESSENTIAL FUNCTIONS: - Reliable and punctual attendance is essential; expected to be at job as scheduled each day. - Communicate necessary information to others as appropriate. Operational Leadership - Manage day-to-day prior authorization activities, ensuring productivity, accuracy,and compliance standards are consistently met. - Supervise, coach, and develop team members to achieve performance goals andmaintain high engagement. - Establish clear expectations and accountability measures across the team. KPI Development & Performance Management - Develop, implement, and monitor KPIs to evaluate team and process performance(e.g., turnaround time, approval rates, denial rates, first-pass resolution). - Use KPI dashboards to identify gaps, measure success, and drive data-informeddecision-making. - Regularly report performance metrics to leadership with actionable insights andrecommendations. Process Improvement & Auditing - Conduct ongoing audits of current prior authorization workflows to identifyinefficiencies, compliance risks, and opportunities for optimization. - Lead process improvement initiatives using metrics and industry standards. - Standardize best practices and ensure consistent implementation across thedepartment. Data Analysis & Trend Identification - Collect, analyze, and interpret data to identify trends, patterns, and root causes ofissues such as denials or delays. - Develop and maintain reporting tools to track volume, payer behavior, and teamperformance. - Partner with leadership to proactively address trends and implement correctiveactions. Compliance & Quality Assurance - Ensure adherence to payer requirements, regulatory guidelines, and internalpolicies. - Oversee quality assurance programs, including routine audits and feedback loopsto maintain accuracy. - Stay current on industry changes and update processes accordingly. Cross-Functional Collaboration - Collaborate with clinical, billing, and administrative teams to streamline priorauthorization processes and improve patient and provider experience. - Serve as a liaison between departments and external stakeholders, includingpayers. Wage starts at $29.00 per hour and goes up base on experience