Prior Authorization Supervisor

Prior Authorization Supervisor

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JOB SUMMARY

The Prior Authorization Supervisor assists the FSR/Prior Authorization Manager in developing, organizing, and implementing prior authorization operations across Prevea in alignment with Prevea's mission, vision, and values. This role provides direct supervision of Prior Authorization Specialists and Leads across all service areas and phases of the consolidation, ensuring consistent use of Epic referral modules and work queues, adherence to authorization documentation standards, and timely processing of all prior authorizations. The Supervisor serves as a key liaison between prior authorization staff, the Business Office, IT, and clinical departments, and supports process improvement, workflow efficiency, and regulatory compliance.

Essential Functions

• Performs full range of supervisory responsibilities for Prior Authorization Specialists and Leads including coaching, development, performance management, scheduling, and work assignment. Provides frontline supervision across all departments with centralized prior authorization staff.
• Ensures all Prior Authorization Specialists follow established Epic and departmental standards for authorization processing, documentation, and work queue management. Monitors work queue performance and escalates as needed.
• Collaborates closely with IT on Epic workflow configuration, referral module setup, work queue management, and any build needs related to prior authorization processes. Identifies and surfaces workflow gaps or system issues that affect authorization processing.
• Works closely with the Business Office to support proactive denial management, communicate payer requirement changes to staff, and identify authorization-related denial trends. Provides input on workflows that affect front-end authorization and back-end denial resolution.
• Identifies patient care issues, decision-making challenges, and staff concerns related to prior authorization processes. Facilitates resolution and supports staff in professional growth and keeping current with payer requirements and Epic workflows. Collaborates with clinical departments to address authorization-related questions, communicate requirements, and support continuity of care.
• Provides Epic and workflow support to staff; assists with onboarding, training, and process development; contributes to building and maintaining the Prior Authorization SharePoint and Teams resources. Performs prior authorization duties when necessary to maintain continuity.
• Communicates latest payer, regulatory, and workflow information to staff in a timely manner. Coordinates changes with the Manager and relevant departments. Maintains confidentiality of all management, staff, and patient information.

Required for All Jobs

• Performs other duties as assigned
• Complies with all organizational polices, standards, and HIPAA regulations to safeguard patient and confidential information.
• Participates in professional development activities and maintains professional affiliations and certifications, if applicable.

QUALIFICATIONS

• High School Diploma and/or GED - Required
• Associate's Degree in healthcare, business, or related field - Preferred

Work Experience

• 2+ years experience in prior authorization, insurance, or healthcare revenue cycle - Required
• 1+ years leadership or supervisory experience, or successful completion of leadership education - Preferred
• 1+ years experience with EPIC referral and prior authorization workflows

Knowledge, Skills and Abilities

• Knowledge of prior authorization processes, payer requirements, and insurance guidelines across procedures, diagnostic tests, services, and medications.
• Proficient in Epic referral modules, work queues, and in-basket; ability to support and train staff in these workflows.
• Ability to lead teams and manage conflict effectively; experience supervising staff across multiple service areas.
• Excellent interpersonal, organizational, and communication skills; ability to form professional relationships with staff, clinical departments, the Business Office, and IT.
• Capable of implementing and advising on process change; adapts effectively to changing payer requirements and workflows.
• Ability to prioritize work and meet changing demands across multiple concurrent prior authorization teams.
• Ability to understand and communicate prior authorization data, work queue performance, and denial trends to the Manager.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Knowledge of medical terminology and basic CPT/ICD coding.
• Fosters a culture of accountability, cross-coverage, and collaboration among Prior Authorization Specialist teams and across clinical departments.

Physical Requirements

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Please note that when carrying or lifting anything at or above 50 lbs - especially if doing so overhead - this action needs to be completed with assistance of others or appropriate lifting equipment

Hazard statement: Employees (particularly those in a clinical setting) may have potential exposure to hazardous drugs, chemicals, and blood or body fluids as part of routine job duties or incidental contact within the healthcare environment. Exposure risk may occur through direct patient care activities, handling of medications or specimens, equipment cleaning, waste disposal, environmental services, maintenance activities, or presence in clinical areas.

All employees are expected to follow applicable established infection prevention, hazardous drug handling, chemical safety, and personal protective equipment (PPE) policies to minimize exposure risk and ensure a safe work environment.

Physical Demand

N/A

Rarely

Occasionally

Frequently

Constantly

Sit

X

Stand

X

Walk

X

Drive

X

Climb (Stairs/Ladders)

X

Bend (Neck)

X

Gross Manipulation (Hands/Arms)

X

Squat

X

Kneel/Crawl

X

Twist/Turn (Neck)

X

Twist/Turn(Waist)

X

Lift/Carry 0-10 lbs.

X

Lift/Carry 11-25 lbs.

X

Lift/Carry 26-35 lbs.

X

Lift/Carry 36-50 lbs.

X

Lift/Carry 51-75 lbs.

X

Lift/Carry 76-100 lbs.

X

Lift/Carry > 100 lbs.

X

Push/Pull up to 10 lbs.

X

Push/Pull 11-25 lbs.

X

Push/Pull 26-35 lbs.

X

Push/Pull 36-50 lbs.

X

Push/Pull 51-75 lbs.

X

Push/Pull 76-100 lbs.

X

Push/Pull > 100 lbs.

X

Reach (Above shoulder level)

X

Reach (Below shoulder level)

X

Simple Grasping (Hands/Arms)

X

Fine Manipulation (Hands/Arms)

X

Gross Manipulation (Hands/Arms)

X

Vision Requirements

Physical Demand

N/A

Rarely

Occasionally

Frequently

Constantly

Color Discrimination

X

Near Vision (Correctable to Jaeger 2 or 20/40 binocular)

X

Distance Vision (Correctable to Snellen chart 20/40 binocular)

X

Hearing Requirements

Physical Demand

N/A

Rarely

Occasionally

Frequently

Constantly

Hears Whispers < 3 feet

X

Hears Whispers 3-8 feet

X

Working Environment

While performing the duties of this job, the associate is required to work within the selected working environments.

Working Condition

N/A

Rarely

Occasionally

Frequently

Constantly

Extreme cold

X

Extreme heat

X

Humidity

X

Wet

X

Noise

X

Hazards

X

Travel Requirements

Estimated Amount

Brief Description

5%

Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify