Manager of Payer Connectivity optimizing healthcare prior authorization processes. Enhancing automation and interoperability while collaborating with cross-functional teams for effective delivery.
Responsibilities
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
Requirements
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
Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field (preferred)
5+ years of experience in healthcare operations, payer/provider connectivity, or health tech product management (preferred)
Prior experience working with EHR platforms and healthcare IT vendors (preferred)
Familiarity with Agile development methodologies and sprint management (preferred)
Benefits
Competitive total rewards (base salary + bonus, if applicable)
Customizable benefits package (3 medical plans with Health Saving Account company match)
Generous paid time off for our non-exempt team members, starting with 3 weeks + 13 paid holidays, including 2 personal floating holidays
Flexible time off for our exempt team members + 13 paid holidays
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