Operations Manager

Investigate, troubleshoot, and resolve eligibility, benefits, prior authorization, and coverage nuances across patients and health plans. Trace stuck orders to root causes—such as coverage lapses, plan mismatches, or documentation gaps—and drive resolutions to prevent recurrence. Own prior authorization submissions, appeals, and denials while maintaining working knowledge of Medicaid, Medicare, and commercial payer rules across active states. Build systems by developing SOPs and converting recurring investigations into repeatable, automated workflows. Track key performance indicators including eligibility hit rate, auth turnaround, and denial rates to surface insights to leadership. Report to the Head of Operations while collaborating with RCM, fulfillment, and product teams to keep orders clean and compliant.