Manager, Prior Authorization Payer Connectivity

ABOUT THIS POSITION

The Manager of Payer Connectivity for Prior Authorization plays a pivotal role in optimizing how healthcare providers and payers exchange information related to prior authorizations. This leader is responsible for enhancing the technical infrastructure and administrative workflows that support insurance approval processes, aiming to reduce delays in patient care and improve overall efficiency. The role serves as a strategic bridge between payer requirements, provider workflows, and technology solutions, ensuring streamlined, compliant, and scalable connectivity.

WHAT YOU'LL DO

• Develop and execute strategies to enhance the automation and interoperability of prior authorization workflows across providers, vendors, and payers. 

• Define and maintain a payer connectivity roadmap aligned with organizational goals and report progress to executive leadership. 

• Collaborate with engineering, development, and product teams to integrate payer-specific requirements into EHR systems and the Waystar platform. 

• Drive initiatives that enable automated submission, tracking, and response handling for prior authorization requests. 

• Identify pain points and inefficiencies in current prior authorization processes. 

• Design and implement scalable, automated solutions that streamline workflows and reduce manual effort. 

• Act as the liaison between internal teams and external payer/provider stakeholders. 

• Translate payer needs and industry insights into actionable product and technical requirements. 

• Lead, mentor, and develop a team responsible for managing payer connectivity, requirements gathering, and validation criteria. 

• Ensure backlog refinement, sprint planning, and retrospectives are executed effectively. 

• Provide clarity of goals and equip team members with tools and knowledge for successful delivery. 

• Ensure all payer connectivity solutions meet regulatory and industry standards for privacy, security, and data exchange. 

• Monitor policy changes and adjust solutions accordingly to maintain compliance. 

WHAT YOU'LL NEED

• Proven ability to manage cross-functional teams and lead change in a dynamic healthcare or technology environment. 

• Excellent verbal and written communication skills for interacting with payers, providers, and internal stakeholders at all levels. 

• Deep understanding of healthcare administration, payer operations, and prior authorization processes. 

• Familiarity with regulatory requirements (e.g., HIPAA, CMS mandates) related to data exchange.  

• Experience working with payer connectivity tools, healthcare interoperability standards (e.g., HL7, FHIR, X12 278), and automation technologies. 

• Ability to analyze complex workflows, identify improvement opportunities, and drive continuous enhancements. 

 

Preferred Qualifications: 

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field. 

• 5+ years of experience in healthcare operations, payer/provider connectivity, or health tech product management. 

• Prior experience working with EHR platforms and healt