Senior Clinical Operations Manager

2 days ago

Hyderabad, Telangana, India beBeeTeamLead Full time ₹ 80,00,000 - ₹ 1,20,00,000
Job Description

As a Prior Authorization Team Lead, you will oversee and coordinate the daily operations of the prior authorization team. This role requires strong leadership, payer policy knowledge, and the ability to coach team members to meet productivity and quality standards.

  • 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.
Key Responsibilities:

The ideal candidate will have in-depth knowledge of cardiology, radiology, orthopaedics, and medication prior authorization workflows.

  • 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

You will be responsible for verifying patient eligibility and insurance benefits prior to scheduling services.

  • 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

This role ensures compliance with HIPAA, payer guidelines, and internal policies.

  • 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

As a Prior Authorization Team Lead, you will work closely with providers, schedulers, and billing teams to ensure accurate authorization and verification workflows.

  • 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

The ideal candidate will possess the following skills and qualifications:

  • 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.
Benefits

As a member of our team, you will enjoy the following 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.

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