Team Lead - Prior Authorization (Hospital Billing - Inpatient Service)

ECLAT Health Solutions; Mumbai; On-site; INR 1,200,000 - 2,000,000; Full time

Job summary

ECLAT Health Solutions is seeking an experienced Team Lead – Prior Authorization to manage inpatient hospital authorization operations and ensure timely approvals. The role focuses on maintaining process quality, productivity, and coordination with insurers and hospitals.

You will oversee the PA team, monitor SLA adherence, handle escalations, and drive continuous process improvements in a night-shift capacity. Relevant experience in US Healthcare RCM is required.

Qualifications

• Experience leading inpatient hospital authorization teams.
• Strong knowledge of US payer guidelines and medical necessity.
• Excellent communication and leadership capabilities.

Responsibilities

• Lead and manage the inpatient prior authorization team in US Hospital Billing.
• Oversee authorization requests, approvals, extensions, and follow-ups with payers.
• Ensure timely submission of clinical documentation and medical necessity information.
• Coordinate with insurance companies, hospitals, and internal teams to resolve issues.
• Monitor productivity, quality, turnaround time, and SLA adherence.
• Identify denials and implement corrective actions.
• Conduct team huddles, coaching, and training.
• Prepare daily and monthly performance reports and drive improvements.

Skills

Team management

Communication

Analytical skills

US healthcare knowledge

Job description

7 - 11 Years

Full-Time

Job Summary:

We are looking for an experienced Team Lead – Prior Authorization to manage inpatient hospital authorization operations, ensure timely authorization approvals, and maintain process quality and productivity.

Key Responsibilities:

• Lead and manage the inpatient prior authorization team in US Hospital Billing.
• Oversee authorization requests, approvals, extensions, and status follow-ups with insurance payers.
• Ensure timely submission of clinical documentation and medical necessity information.
• Coordinate with insurance companies, hospitals, and internal teams to resolve authorization-related issues.
• Monitor team productivity, quality, turnaround time (TAT), and SLA adherence.
• Identify authorization-related denials and implement corrective actions.
• Conduct team huddles, performance reviews, coaching, and process training.
• Prepare daily and monthly performance reports and drive continuous improvement.

Required Skills & Qualifications:

• 7–11 years of experience in US Healthcare RCM, with strong expertise in Prior Authorization.
• Minimum 1–2 years of experience as a Team Lead handling inpatient hospital authorization.
• Strong knowledge of US insurance processes, payer guidelines, medical necessity, and inpatient authorization requirements.
• Experience handling authorization escalations, team performance, and quality metrics.
• Excellent communication, analytical, and team management skills.

Shifts : Night Shifts