Job Summary

The Prior Authorization Team Lead oversees a team of specialists responsible for obtaining prior authorizations from insurance companies for outpatient diagnostic testing.  Team Lead ensures timely and accurate processing while adhering to payer policies.  Team Lead reviews complex cases, resolves issues, trains new staff, and monitors performance metrics to optimize patient access to necessary care.

Principal Duties and Responsibilities (*Essential Functions)

• Assign and delegate prior authorization request to team members based on workload and expertise

• Monitor team performance, identify areas for improvement, provide coaching and feedback alongside department manager

• Conduct regular team meeting to discuss workflow, challenges, and policy updates

• Train and mentor new prior authorization specialist on company procedures, payer guidelines and relevant software

• Performs duties of Prior Authorization Specialist

• Performs other duties as needed and/or assigned

Job Specific (Minimum Qualificationd)

Knowledge, Skills, and Abilities

• Knowledge of insurance prior authorization and medical terminology
• Demonstrates exceptional customer service skills
• Provides staff feedback and education

• Ability to motivate, guide, and develop a team

• Acts as reference source for staff (Subject matter expert) prior authorizations, insurance portals, hospital/department policies/procedures

• Adheres to and monitors staff authorization work ques

• Meets or exceeds all Methodist Hospital employee standards (ex. attendance, productivity, QA, customer service)

• Supports all management initiatives

• Works closely with other departments to promote efficiency and timely authorizations

• Evaluates operations of department and makes recommendations to manager and director

• Medical terminology knowledge

• Ability to prioritize job functions, work independently and exercise good judgement

• Must possess good written and verbal communication skills

• Basic computer skills

Education

• High School Diploma/GED Equivalent in General Studies is Required

•  Bachelors Degree in Business/Management is Preferred

Experience

• 3 Years experience in Prior Authorization Physician office/Hospital based is Required

Certifications and Licensures

• Certified Professional Coder (CPC) is Preferred

Model of Care and Conduct

Methodist Hospitals strives for excellence and insists on high standards of conduct and performance in everything we do. Our Model of Care and Conduct is designed to create a positive work environment which Methodist desires for all employees. This is foundational to the high level of patient, family and physician satisfaction we strive for each day. As part of all position’s duties at Methodist Hospitals, all employees are responsible to conduct themselves in accordance with the Model of Care and Conduct and will be evaluated according to these standards of behavior.