Insurance Pre-Authorization Team Leader

Job Summary

The Team Lead - Insurance Pre-Authorization will coordinate the authorization of medical services with insurance payers locally and internationally. He/ She will monitor all authorization processes for meeting coordination of care, timeliness standards, cost effectiveness, tracks, and trends production of staff; and assist to ensure clinical criteria are utilized and applied to determine medical necessity.

Job Responsibilities 1

Reviews and authorizes, as appropriate, Prior authorization requests per established formulary and Prior authorization protocol per payer standards.

Researches requests not clearly meeting established criteria.

Assists the Prior Authorization team with the prior authorization process.

Achieves the overall operations and goals of the department.

Uses a thorough verification process to know the services covered to obtain pre-authorization.

Maintains complete documentation and record of all necessary information.

Job Responsibilities 2

Maintains an amicable relationship with insurance providers.

Understands the contract terms and process of various insurance providers and adheres to their guidelines to avoid delays and denials.

Uses standard templates to avoid documentation and human errors.

Provides necessary training in all necessary procedures to all required staff.

Communicates job expectations to RCM staff.

Plans, assigns, monitors, and appraises employees job performance, by maintaining, training, orienting, mentoring, and evaluating them.

Ensures that work completed by staff is timely, accurate, and complete as per policies and procedures.

Performs other assignments as may be required by the management.

Ensures adherence to the Hospital’s and Finance department’s policies, procedures, and Code of Ethics and reports any deviations/noncompliance.

Additional Responsibilities 3

Job Knowledge & Skills

Effective time management skills.

Effective interpersonal and communication skills.

Excellent customer service.

Ability to supervise and lead others.

Ability to think analytically and make decisions.

Ability to manage a large workload.

Ability to maintain a positive work environment for employees. 

Job Experience

5+ years of experience in Prior Authorization/ Insurance.

5+ years of experience with administering appeals in a high-volume.

3 years’ experience with using electronic medical records and claims systems.

2 years direct supervisory experience.

Minimum 2 years in GCC (preferred)

Competencies

Education