Prior Authorization Manager

The Prior Authorization Manager is responsible for leading and optimizing the pre-service clearance process to ensure timely access to Vivistim® Paired VNS™ Therapy. Reporting to the Market Access Director, this role will guide prior authorization workflows, payer engagement strategies, and process improvements, serving as a key resource for both internal teams and external stakeholders.

This position works closely with healthcare providers, rehabilitation clinics, payers, and the field sales team to streamline authorization processes, troubleshoot payer-related challenges, and develop best practices that improve efficiency and approval rates. The Prior Authorization Manager will also play a key role in data analysis, training initiatives, and process optimization to enhance the effectiveness of the prior authorization function.

As a senior member of the Market Access team, this role will support the development of training programs, reporting tools, and strategic insights to drive operational excellence in prior authorization and payer access.

POSITION RESPONSIBILITIES / ESSENTIAL FUNCTIONS:

• Lead and refine the prior authorization process, ensuring efficient and accurate submission of authorization requests and appeals.

• Act as a subject matter expert (SME) on prior authorization workflows, payer engagement strategies, and pre-service clearance best practices.
• Monitor and analyze payer authorization trends, identifying opportunities to improve internal processes and payer interactions.
• Serve as an escalation point for complex authorization denials, working with payers and providers to facilitate resolution.
• Collaborate with healthcare providers and revenue cycle teams to address documentation gaps and improve prior authorization success rates.
• Partner with the field sales team to provide guidance on payer requirements and develop strategies to support provider offices in securing approvals.
• Develop and refine training materials and educational programs for internal teams and provider offices on prior authorization best practices and payer requirements.
• Ensure compliance with HIPAA, payer policies, and regulatory requirements in all prior authorization activities.
• Maintain accurate reporting and dashboards, tracking authorization success rates, turnaround times, and payer-specific trends.
• Provide strategic insights to leadership on prior authorization challenges, policy trends, and opportunities for process optimization.
• Work cross-functionally to enhance the overall efficiency and effectiveness of the prior authorization function.
• Other duties as assigned.

QUALIFICATIONS & EXPERIENCE:

• Minimum 8 years of experience in prior authorization, commercial payer policy navigation, or revenue cycle management, preferably in medical device, neurostimulation, or rehabilitation therapies.
• Expertise in prior authorization workflows, commercial payer appeals, and reimbursement processes.
• Strong understanding of commercial insurance plans and their prior authorization requirements.
• Proficiency in CPT, HCPCS, and ICD-10 coding, as well as medical necessity documentation best practices.
• Experience with payer policy review, insurance verification, and authorization tracking systems.
• Strong analytical skills with the ability to interpret payer data, identify trends, and develop strategic recommendations.
• Education: Minimum Bachelor’s degree required.
• Preferred Certifications: CPC or similar coding and revenue cycle certification.
• Experience with Salesforce®, EPIC Systems®, or other EHR/ERP systems is a plus.

POSITIONAL COMPETENCIES:

• Subject Matter Expertise – Serves as a functional leader in prior authorization strategy and payer engagement.
• Strategic Thinking – Identifies opportunities to refine workflows, improve efficiencies, and enhance the authorization process.
• Collaboration – Works cross-functionally with providers, payers, and internal teams to optimize patient access.
• Problem-Solving & Adaptability – Proactively addresses authorization challenges and navigates evolving payer landscapes.
• Process Improvement – Continuously assesses and enhances workflows to drive operational excellence.

MicroTransponder provides a comprehensive benefits program to employees.  It includes medical, dental and vision plans along with an FSA.  Employees may participate in the company 401(k) plan with company matching.  The company offers an unlimited Paid Time Off (PTO) program and approximately 15 paid company holidays per year.