Lead Precertification Specialist

Medical University of South Carolina•Charleston, SC

2d•Onsite

About The Position

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout the state of South Carolina. The Precertification Specialist Team Lead reports to the Central Precert Unit Supervisor and oversees daily operations of the preauthorization team to ensure timely, accurate, and compliant authorization of medical services. This role provides leadership, coaching, and workflow coordination while serving as a subject matter expert for payer requirements, medical necessity guidelines, and authorization processes. The Team Lead acts as a liaison between staff, providers, and payers to support optimal patient access and revenue integrity.

Requirements

Subject matter expert for payer requirements, medical necessity guidelines, and authorization processes
Ability to act as a liaison between staff, providers, and payers
Experience in leading, mentoring, and supporting staff
Proficiency in assigning and prioritizing workloads
Experience serving as an escalation point for complex cases
Skills in onboarding, training, and ongoing staff education
Ability to provide coaching, feedback, and performance input
Experience in reviewing, processing, and overseeing authorization requests
Knowledge of compliance with payer policies, medical necessity criteria, and internal workflows
Ability to collaborate with clinical teams
Experience in monitoring authorization status
Proficiency in maintaining accurate documentation in EHR and practice management systems
Experience in monitoring key performance indicators (KPIs)
Ability to conduct quality audits and provide corrective guidance
Skills in identifying root causes of denials and process gaps
Experience in supporting denial prevention strategies and appeals
Ability to recommend and assist with process improvement initiatives
Strong communication skills for interacting with providers, payers, and internal departments
Ability to communicate payer updates, policy changes, and workflow expectations
Experience in participating in meetings related to patient access, utilization management, and revenue cycle performance
Ability to escalate risks or delays to leadership
Skills in assisting with report preparation
Ability to support policy, procedure, and workflow documentation updates

Nice To Haves

Experience working with energetic enthusiastic individuals

Responsibilities

Lead, mentor, and support preauthorization staff to meet productivity, quality, and turnaround time standards
Assign and prioritize workloads based on service urgency and payer requirement
Serve as escalation point for complex, urgent, or denied authorization cases
Assist with onboarding, training, and ongoing staff education
Provide coaching, feedback, and performance input to management
Review, process, and oversee complex or high-risk authorization requests
Ensure compliance with payer policies, medical necessity criteria, and internal workflows
Collaborate with clinical teams to obtain accurate and complete documentation
Monitor authorization status to prevent delays in patient care or scheduled services
Maintain accurate documentation in EHR and practice management systems
Monitor key performance indicators (KPIs) including turnaround time, approval rates, and denial trends
Conduct quality audits and provide corrective guidance to staff
Identify root causes of denials and process gaps
Support denial prevention strategies and appeals when needed
Recommend and assist with process improvement initiatives
Serve as primary point of contact for providers, payers, and internal departments regarding authorization issues
Communicate payer updates, policy changes, and workflow expectations to staff
Participate in meetings related to patient access, utilization management, and revenue cycle performance
Escalate risks or delays to leadership in a timely manner
Assist with preparation of reports related to productivity, quality, and authorization outcomes
Support policy, procedure, and workflow documentation updates
Perform other duties as assigned to support departmental goals