Precertification/Authorization Specialist Lead

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
• Meets productivity, quality, and turnaround time standards
• Assigns and prioritizes workloads based on service urgency and payer requirement
• Serves as escalation point for complex, urgent, or denied authorization cases
• Assists with onboarding, training, and ongoing staff education
• Provides coaching, feedback, and performance input to management
• Reviews, processes, and oversees complex or high-risk authorization requests
• Ensures compliance with payer policies, medical necessity criteria, and internal workflows
• Collaborates with clinical teams to obtain accurate and complete documentation
• Monitors authorization status to prevent delays in patient care or scheduled services
• Maintains accurate documentation in EHR and practice management systems
• Monitors key performance indicators (KPIs) including turnaround time, approval rates, and denial trends
• Conducts quality audits and provides corrective guidance to staff
• Identifies root causes of denials and process gaps
• Supports denial prevention strategies and appeals when needed
• Recommends and assists with process improvement initiatives
• Serves as primary point of contact for providers, payers, and internal departments regarding authorization issues
• Communicates payer updates, policy changes, and workflow expectations to staff
• Participates in meetings related to patient access, utilization management, and revenue cycle performance
• Escalates risks or delays to leadership in a timely manner
• Assists with preparation of reports related to productivity, quality, and authorization outcomes
• Supports policy, procedure, and workflow documentation updates
• Performs other duties as assigned to support departmental goals

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

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