Key Responsibilities:
- Lead and manage Prior Authorization operations.
- Ensure timely and accurate submission of authorizations.
- Handle team performance, reviews, and escalations.
- Participate in client calls and ensure SLA compliance.
- Track key metrics like approval rates and turnaround time.
Skills Required:
- Minimum 6+years of experience in US healthcare processes, with at least 1 years in a Team Lead role (on paper) for Prior Authorization
- Robust knowledge of Prior Authorization workflows, payer guidelines, and pre-cert requirements
- Add-on experience in Eligibility and Benefits Verification is a strong advantage
- Excellent communication and interpersonal skills must be comfortable leading client discussions
- Strong team management, performance tracking, and escalation handling skills
- Familiarity with EHR/EMR systems and payer portals.
Good to Have:
- Knowledge of insurance plans (Commercial, Medicare, Medicaid)
- Experience in handling multi-specialty authorizations (Radiology, Surgery, DME, etc.)
- Exposure to quality metrics and reporting tools
- Understanding of HIPAA and compliance regulations