Lead Precertification Specialist

Medical University of South Carolina • Charleston, SC

3d • Onsite

About The Position

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

• Reports to the Central Precert Unit Supervisor
• Oversees daily operations of the preauthorization team
• Ensures timely, accurate, and compliant authorization of medical services
• Provides leadership, coaching, and workflow coordination
• Serves as a subject matter expert for payer requirements, medical necessity guidelines, and authorization processes
• Acts as a liaison between staff, providers, and payers
• Supports optimal patient access and revenue integrity
• Works with energetic enthusiastic individuals

Nice To Haves

• Subject matter expert for payer requirements, medical necessity guidelines, and authorization processes

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

Benefits

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed