Role & responsibilities

- Lead and manage the Pre-Authorization team responsible for authorization initiation,

follow-up, status verification, and closure with insurance companies and TPAs.

• Manage day-to-day operations and ensure the team consistently meets productivity,

quality, accuracy, TAT, and SLA targets.

• Ensure timely and accurate initiation of pre-authorization requests by validating patient demographics, insurance eligibility, benefits, authorization requirements, and payer-

specific guidelines.

• Oversee authorization follow-up activities and ensure pending, denied, delayed, and

urgent cases are appropriately tracked and escalated.

• Monitor voice interactions with insurance companies/TPAs to ensure professional

communication, process adherence, accurate information exchange, and effective call

handling.

• Ensure accurate and complete documentation of authorization cases, including payer

interactions, authorization status, follow-up dates, reference numbers, and relevant notes

in healthcare systems.

• Monitor authorization queues, aging reports, pending cases, and workload distribution to

ensure timely resolution and effective case prioritization.

• Conduct regular team huddles, performance reviews, and one-on-one sessions to

communicate business priorities, process updates, quality alerts, and performance

expectations.

• Coach and mentor associates on pre-authorization processes, payer guidelines, voice

communication, documentation standards, quality requirements, and escalation handling.

• Identify performance gaps and implement appropriate coaching,



corrective action, and

performance improvement plans to drive individual and team performance.

• Partner with Quality and Training teams to identify recurring errors and implement

corrective and preventive action plans.

• Conduct and participate in calibration sessions with Quality, Operations, and Training

teams to ensure consistent application of SOPs and quality parameters.

• Perform root-cause analysis for authorization errors, documentation gaps, delayed

follow-ups, payer discrepancies, and other process issues.

• Handle complex and escalated authorization cases, including urgent requests, delayed

approvals, payer disputes, pending cases, and authorization-related challenges.

• Coordinate with internal stakeholders including Quality, Training, Operations, Billing,

Coding, Clinical teams, and Client teams to resolve authorization issues effectively.

• Ensure compliance with client SOPs, payer guidelines, healthcare regulations, data

privacy requirements, and organizational policies.

• Monitor team performance through key metrics such as quality score, productivity,

accuracy, TAT, SLA adherence, attendance, utilization, and case aging.

• Prepare and publish daily, weekly,



and monthly MIS reports, dashboards, productivity

reports, quality reports, and performance trackers for management review.

• Analyze performance trends and provide actionable insights and recommendations to

improve operational efficiency and service quality.

• Identify process bottlenecks and drive continuous improvement initiatives to enhance

first-time-right accuracy, productivity, turnaround time, and overall process

efficiency.

• Support new-hire recruitment, onboarding, process training, nesting, and refresher

training in coordination with Training and Operations teams.

• Ensure effective workload allocation and staffing management based on business

volumes, priority cases, absenteeism, and operational requirements.

• Participate in client meetings and business reviews, providing updates on operational

performance, authorization trends, escalations, challenges, and improvement plans.

• Maintain solid working relationships with internal and external stakeholders to ensure

smooth and efficient authorization operations.

• Recognize high-performing employees and support employee engagement, career

development, and retention initiatives.

• Drive a culture of quality, accountability, ownership, compliance, and continuous

improvement across the Pre-Authorization team.

Preferred candidate profile

- Minimum 6+ Years of experience into Pre Authorization(Voice)
- And minimum 6 months of experience as Team Lead on Papers.
- Excellent communication skills

📌 Pre Authorization - Team Lead (Visakhapatnam)
🏢 Talentboon Consulting
📍 Visakhapatnam