Prior Authorization Team Lead
Location
United States
Posted
1 day ago
Salary
$23 / hour
Seniority
Senior
Job Description
Prior Authorization Team Lead
Point Health
• Collect and review documentation required for prior and retro authorization requests. • Review payer medical necessity guidelines and authorization requirements. • Communicate with practices to obtain additional information needed for procedures and medication requests. • Navigate payer portals and monitor provider and clinic communications to ensure timely responses. • Document account activity and maintain accurate patient and claim information. • Monitor procedure trackers and assist leadership in identifying workflow gaps. • Serve as a subject matter expert on medical policies, departmental procedures, and affiliate workflows. • Lead team huddles, distribute meeting notes, and assist with team training, mentoring, audits, and cross-coverage. • Support new practice and procedure integrations, including workflow and SOP development. • Identify authorization trends or issues that may delay claims processing and recommend solutions. • Collaborate with practices, vendors, insurance carriers, patients, management, and internal teams. • Provide outstanding customer service and support throughout the department. • Perform other related duties as assigned.
Job Requirements
- High School Diploma or GED required.
- At least one (1) year of prior authorization experience in a clinical setting required.
- Excellent verbal and written communication skills.
- Strong organizational, analytical, and problem-solving abilities.
- Proficiency with Microsoft Office Suite or similar software.
- Extensive knowledge of medical policies and LCDs related to pain management procedures.
- Basic understanding of medical terminology.
- Experience navigating payer portals to obtain authorizations and review medical policies.
Benefits
- Health, Dental & Vision Insurance
- Accident and Life/AD&D Insurance
- Short & Long-Term Disability
- Emergency Travel Assistance Program
- ID-Theft Protection Services
- Health Savings Account (HSA)
- Health Management Tools
- Paid Time Off (PTO)
- Company Paid Holidays
- Paternal Leave
- 401(k)
- Remote Stipend
- Travel Reimbursement
- Continuing Education Reimbursement
- Bonusly Employee Recognition Platform
- DailyPay On-Demand Pay Access
- LifeMart Employee Discount Program
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