Prior Authorization Team Lead

Job Description

Job Title: Prior Authorization Team Lead

Location: Kondapur, Hyderabad - ONSITE

Shift Timing: U.S. Time Zone - Indian night shifts

Department: Revenue Cycle / Prior Authorization

We appreciate the value of your time as well as ours, so please review the entire job description and apply only if you are interested.

At Staffingly, Inc., we are at the forefront of revolutionizing healthcare operations by providing essential services to doctors, laboratories, pharmacies, and other healthcare providers. As a leader in economic Prior Authorization solutions, we tackle the challenges of staff shortages that impact revenue flow and patient care quality. Our mission is to empower healthcare facilities to focus on what truly matters, exceptional patient care by simplifying and streamlining their administrative processes.

Our comprehensive service offerings include handling intricate Prior Authorization processes, accurate insurance verifications, expert management of medication and procedural authorizations, full-spectrum Revenue Cycle Management (RCM), Medical Billing/Coding, Data Entry, and Customer Support services. With 24/7 operations, we ensure efficiency and responsiveness, supporting our clients in maintaining smooth and effective healthcare delivery.

If youre passionate about making a meaningful impact in the healthcare industry by improving operational efficiencies and enhancing patient care, Staffingly, Inc. is the place for you. We are eager to see how your skills and expertise can contribute to our growth and success. For more information, visit us at https://staffingly.com

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Position Summary:

The Prior Authorization Team Lead will oversee and coordinate the daily operations of the prior authorization team, ensuring timely and accurate processing of prior authorizations, eligibility verification, and benefits verification. The ideal candidate will have in-depth knowledge of cardiology, radiology, orthopaedics, and medication prior authorization workflows. This role requires strong leadership, payer policy knowledge, and the ability to coach team members to meet productivity and quality standards.

Key Responsibilities:

Team Leadership & Oversight

- Supervise, train, and mentor prior authorization staff.
- Monitor workload distribution and ensure timely completion of all authorization requests.
- Provide performance feedback, coaching, and training to enhance staff knowledge and efficiency.

Prior Authorization Processing

- Review and process prior authorization requests for cardiology, radiology, orthopaedics, and medications in compliance with payer guidelines.
- Ensure all necessary clinical documentation is complete for submission.
- Serve as a subject matter expert for specialty-specific prior authorizations.

Eligibility & Benefits Verification

- Oversee teams verification of patient eligibility and insurance benefits prior to scheduling services.
- Interpret payer benefit coverage, limitations, co-payments, deductibles, and out-of-pocket costs.
- Escalate and resolve complex coverage or benefit disputes.

Compliance & Quality

- Ensure compliance with HIPAA, payer guidelines, and internal policies.
- Monitor and maintain quality assurance metrics and audit results.
- Stay current with payer requirements, coding updates, and industry best practices.

Collaboration

- Work closely with providers, schedulers, and billing teams to ensure accurate authorization and verification workflows.
- Communicate with insurance companies to expedite authorization decisions and resolve issues.
- Act as the liaison between clinical staff and payers for complex or urgent cases.

Qualifications & Skills:

Required:

- Minimum 6 - 12 years of prior authorization experience, with at least 12 years in a lead or supervisory role.
- Strong working knowledge in speciality & Modalities (ophthalmologist, Oncology, Pain Management etc..)
- Proficiency in eligibility and benefits verification using payer portals and clearinghouse tools.
- Strong understanding of insurance payer guidelines, CPT/HCPCS/ICD-10 codes.
- Excellent communication, leadership, and problem-solving skills.
- Ability to work in a fast-paced environment and manage competing priorities.

Preferred:

- Experience with EHR systems (Cerner, Athena, Allscripts, or similar).
- Familiarity with Medicare, Medicaid, and commercial insurance plans.

Benefits:

- Provident Fund contributions.
- Overtime and holiday pay.
- On-site benefits, including travel allowances and meals.
- Referral and birthday bonuses.
- Night shift allowances.
- Recognition through our 'Employee of the Month' program.