Team Lead - Prior Authorization

The Prior Authorization Team Lead is responsible for overseeing the daily operations of the Prior Authorization team, ensuring the timely, accurate, and compliant processing of all prior authorization requests for medical procedures, medications, or treatments. This role involves leadership, staff development, workflow management, and acting as a subject matter expert for complex cases and payer guidelines.

Key Responsibilities:

Leadership and Team Management:

• Supervise, motivate, and mentor a team of Prior Authorization Specialists, ensuring a positive and productive work environment.
• Monitor daily workloads, workflow distribution, and team productivity metrics (KPIs) to ensure targets are met.
• Provide regular coaching, performance feedback, and ongoing training to staff to enhance knowledge and efficiency.
• Manage scheduling and staffing to ensure adequate coverage and operational efficiency.
• Act as the subject matter expert and first point of escalation for complex, challenging, or denied prior authorization cases.
• Oversee the team's process for verifying patient eligibility, insurance benefits, and confirming the necessity of services.
• Review and process prior authorization requests as needed, ensuring all submissions include complete and accurate clinical documentation and adhere to payer guidelines.
• Coordinate with healthcare providers, clinical staff, and insurance companies to expedite approvals and resolve delays or denials

Desired Candidate:

• 8 to 10 years of experience in prior authorization.
• 1-2 years of experience in a leadership role.
• In-depth knowledge of prior authorization processes, insurance types (e.g., commercial, Medicare, Medicaid), and medical terminology.
• Proficiency with medical billing software, Electronic Health Records (EHRs), and payer portals.
• Excellent written and verbal communication, interpersonal, and customer service skills.
• Strong organizational, problem-solving, and critical-thinking abilities.

Saddla@primehealthcare.com