Prior Authorization Manager

• Enforce established service level agreements, communication cadences, and performance standards, including submission as urgent/expedited without exception, daily follow-up on high-priority cases, and timely escalation protocols 

• Conduct regular vendor performance reviews against defined benchmarks and escalate gaps to leadership 

• Ensure vendors have timely access to clinical documentation, payer requirements, CPT codes, and practice-specific routing information needed to execute authorizations effectively 

• Hold vendors accountable to documentation standards, including properly detailed denial appeal notations and “No Auth Required” reference documentation 

• Serve as the escalation point when vendor submissions require intervention or authorizations remain unresolved past defined thresholds 

Enhanced Services Authorization - CTA Add-On Services

• Oversee the CTA add-on authorization workflow for Plaque Analysis and Ischemia Analysis/FFRct, which works entirely outside standard vendor and EHR-managed authorization pathways 

• Ensure the stateside RCM team is placing authorizations on hold at once upon receipt, submitting to payers prior to any vendor triggering, and documenting all activity within the practice management system 

• Monitor CAD-RADS–based clinical criteria compliance, diagnosis code accuracy, and alignment with approved order sets for analysis vendors 

• Maintain the FFRct pilot patient tracker and coordinate with clinical and RCM staff on payer-specific commercial criteria as they are finalized 

De Novo Practice Onboarding 

• Partner with practice onboarding teams to build authorization workflows for new CardioOne practice partners from the ground up, setting up routing structures, tracker configuration, vendor handoffs, and escalation paths before go-live 

• Coordinate with authorization vendors to ensure coverage is fully operational at the time of launch 

• Identify payer-specific authorization requirements for each new market and translate those into tracker infrastructure and vendor briefs 

Team Leadership & Cross-Functional Collaboration 

• Provide informal or formal oversight to authorization staff, including workload management, quality review, training, and performance feedback as the team scales 

• Collaborate cross-functionally with RCM leadership, credentialing, clinical operations, scheduling staff, and practice administrators to resolve authorization-related barriers to care and revenue 

• Contribute to reporting and analytics surfacing authorization performance trends, approval rates, denial patterns, turnaround benchmarks, and vendor service level agreement adherence to senior leadership 

• Maintain ongoing oversight of high-urgency authorization workflows, STAT prior authorization escalation processes, and facility notification requirements across practice entities 

What you’ll need:

• 5+ years of experience in prior authorization, revenue cycle, or medical billing, with meaningful exposure to cardiology or cardiovascular specialty care 

• Demonstrated experience managing or coordinating with external authorization vendors or outsourced teams, including holding vendors to defined SLAs 

• Strong working knowledge of commercial and government payer authorization requirements for cardiovascular services, with particular emphasis on cardiac imaging and cardiology procedures 

• Proficiency with athenaOne (athenaCollector) or comparable EHR/practice management platforms, including authorization tracker workflows 

• Exceptional organizational skills and the ability to manage authorization operations across multiple simultaneous practice environments 

• Strong written and verbal communication skills, able to hold vendors accountable professionally, escalate issues clearly, and translate workflow complexity for clinical and scheduling staff 

• Self-starter with demonstrated ability to build accountability and a high-performance work culture across distributed teams (RCM, clinical, scheduling, and vendor partners), driving consistent execution and work ethic across entities

• Prior experience authorizing cardiac imaging services including cardiac CT/CTA, PET MPI, echocardiography, nuclear medicine, and cardiac monitoring (MCT/MCOT, Holter, ILR) is a significant advantage and will be weighted heavily in candidate evaluation 

• Cardiology procedure authorization experience**, including surgical and interventional cardiovascular procedures, is a strong plus 

• Experience with enhanced services authorization workflows including CTA add-on services such as plaque analysis and FFRct/ischemia analysis, is highly desirable 

• Familiarity with de novo or newly launched medical practice environments 

• Background in multi-entity or MSO/practice management organization settings 

• Experience building or redesigning authorization workflows, routing structures, and escalation frameworks from the ground up 

Work Location:

• Remote: Colorado (preferred), Washington (preferred), Delaware, Florida, New Hampshire, New Jersey, Pennsylvania, Texas.

Additional Information

Full-time base salary range of $62,000 to $68,000 plus medical, dental, and vision benefits. This role will has a matching 401K.