PRIOR AUTHORIZATION LEAD
Texas Institute for Neurological Disorders / US Neurology Associates
Department: Revenue Cycle / Operations │ Schedule: Full-Time, Monday–Friday │ Location: On-Site, Frisco
POSITION SUMMARY
The Prior Authorization Lead is a senior individual contributor responsible for owning and managing the end-to-end prior authorization workflow across a multi-site outpatient neurology practice serving patients throughout the Dallas Fort Worth area. The individual in this role will own hands-on execution, optimize current workflows, and serve as the subject matter expert as our clinical operations scale. As the department expands, this role is ultimately expected to lead a team of prior authorization specialists. This role requires expertise in neurology-specific (or similar) authorization requirements and a track record of managing high-volume, complex payer environments with minimal supervision.
The Prior Authorization Lead will bring established payer knowledge, process discipline, and the needed clinical vocabulary to communicate effectively with providers, clinical staff, and payer representatives in a fast-paced neurology environment.
KEY RESPONSIBILITIES
Prior Authorization Management
- Own end-to-end prior authorization for all physician visits, procedures (EMG, EEG, infusions, Botox/injections), and ancillary services across multiple clinic locations
- Initiate, track, escalate, and close authorizations within payer-required timelines — with particular attention to WellMed, Medicare Advantage, and Texas Medicaid managed care plans
- Manage denial and appeal workflows: identify denial trends, gather supporting clinical documentation, and coordinate with providers and clinical staff to reverse denials
- Monitor and proactively renew authorizations for ongoing treatment plans before expiration
- Maintain complete and accurate authorization records in eClinicalWorks (eCW)
Workflow Integrity & Scheduling Protection
- Ensure no patient is scheduled for procedures requiring authorization without verified clearance
- Identify and flag high-risk scheduling exceptions prior to appointment confirmation
- Work with scheduling leadership to prevent downstream rescheduling due to authorization failure
- Serve as the escalation point for authorization-related scheduling conflicts and urgent cases
Benefits Verification
- Verify insurance benefits prior to scheduling, including coverage, co-pays, deductibles, and out-of-pocket requirements
- Identify patients requiring financial counseling or payment plan setup and facilitate appropriate referral
- Confirm payer-specific requirements at the point of scheduling to prevent point-of-service surprises
Communication & Coordination
- Serve as the primary internal liaison between scheduling, clinical staff, and external payer and authorization teams
- Serve as the internal subject matter expert, educating and advising scheduling and clinical staff on payer-specific authorization requirements and best practices.
- Proactively communicate authorization status to the scheduling team, flagging at-risk cases within 72 hours of appointment
- Reduce authorization-related call and email volume reaching the scheduling queue by resolving upstream issues
Documentation & Reporting
- Maintain an organized, real-time tracking system for all pending, approved, denied, and appealed authorizations
- Identify process improvement opportunities and optimize workflows to eliminate authorization-related delays and maximize clearance efficiency.
- Produce regular status reports for operations leadership on queue volume, turnaround times, denial rates, and appeal outcomes
QUALIFICATIONS
Required
- Minimum 5 years of prior authorization experience in an outpatient healthcare setting
- Demonstrated experience managing high-volume, complex authorization workflows with minimal supervision
- Strong working knowledge of commercial, Medicare, Medicare Advantage, and Medicaid managed care payer requirements
- Proficiency with eClinicalWorks (eCW) or a comparable EMR/practice management system
- Experience with payer portals including Availity, NaviMedix, and payer-specific platforms
- Ability to manage competing priorities and meet tight deadlines in a fast-paced multi-site environment
- Strong written and verbal communication skills with the ability to engage clinical staff, schedulers, and payer representatives effectively
Preferred
- Prior authorization experience in outpatient neurology - strongly preferred
- Familiarity with neurology-specific procedures and their authorization requirements (EMG, EEG, infusion therapies, Botox, sleep studies)
- Experience with WellMed, UnitedHealthcare, BCBS Texas, and Texas Medicaid managed care plans
- CPAR (Certified Patient Access Representative) or equivalent certification
- Experience in a multi-site outpatient specialty practice
COMPENSATION & BENEFITS
Salary Range
Commensurate with experience
Location
On-Site, Frisco
Benefits
Medical, dental, vision, PTO, 401(k)
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.
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
