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, perks, 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 strong 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