Authorization/ Eligibility Team Lead

USHP•Newark, DE

6d•Remote

About The Position

The Authorization/Eligibility Team Lead oversees the daily operations of a team responsible for verifying patient insurance coverage, determining eligibility for services, and obtaining prior authorizations to support timely access to care. The role provides leadership, training, and support to team members, while monitoring productivity, accuracy, and compliance with insurance requirements and organizational policies. The Team Lead works with insurance companies, healthcare providers, and internal departments to resolve authorization issues, reduce claim denials, improve workflows, and support efficient revenue cycle operations, while maintaining strong customer service and patient satisfaction. The position reports to the Billing Manager and provides day-to-day leadership, workload assignment, training, coaching, and performance oversight for the Authorization/Eligibility team. The role is remote. The employee regularly sits, uses hands and fingers, talks and hears, and reaches with hands and arms. Standing and walking are also required; the employee may lift or move up to 15 pounds.

Requirements

High school diploma or equivalent.
Knowledge of medical billing and coding.
Knowledge of Utilization Management sites such as eviCore, AIM, RadMD, and Navinet.
Proficiency with NextGen Practice Management and EHR.
Excellent verbal and written communication skills.
Excellent interpersonal and customer service skills.
Excellent organizational skills and attention to detail.
Strong time management skills and a proven ability to meet deadlines.
Ability to prioritize tasks and delegate when appropriate.
Ability to function effectively in a fast-paced and sometimes stressful environment.
Professional and ethical conduct, respect and courtesy toward others, and a commitment to exceptional patient customer service.
Ability to maintain strict confidentiality of patient and business information.
Ability to comply with OSHA and HIPAA regulations and organizational policies and procedures.

Nice To Haves

A minimum of 2–3 years of current Authorization/Eligibility Verification experience.

Responsibilities

Oversee daily Authorization/Eligibility team operations, assign workloads, monitor performance, and ensure productivity and quality standards are met.
Ensure patient insurance coverage, benefits, plan limitations, deductibles, copayments, and out-of-pocket responsibilities are verified accurately and promptly.
Oversee submission, tracking, and follow-up of prior authorization requests so services, procedures, or treatments are approved before scheduled appointments.
Monitor daily work queues, prioritize urgent requests, manage pending authorizations, and ensure tasks meet established turnaround times.
Train new employees, provide ongoing coaching, communicate policy updates, and support improvements in accuracy, efficiency, and customer service.
Resolve complex eligibility discrepancies, authorization denials, delayed approvals, and insurance-related issues in collaboration with insurers, providers, and internal departments.
Track performance indicators, including productivity, authorization turnaround times, verification accuracy, pending requests, and denial trends; prepare reports and recommend improvements.
Coordinate with scheduling, registration, billing, coding, clinical teams, and revenue cycle management to prevent care delays and reduce claim denials.
Communicate changes in insurance policies, authorization requirements, payer portals, and eligibility procedures to support team awareness and compliance.
Assist with staffing coverage, schedule coordination, workload distribution, and attendance monitoring.
Identify authorization and eligibility issues that could lead to claim denials or delayed reimbursement, and implement corrective actions to minimize financial impact.
Maintain patient and business information confidentiality and comply with OSHA and HIPAA regulations.
Adhere to organizational policies and procedures, recommend improvements to management, and participate in committees, discussions, and other team functions.