Healthcare Team Leader | Prior Authorization | Pasay

Private Advertiser; Pasay; On-site; PHP 391,000 - 781,000; Full time

Job summary

Private Advertiser in Pasay, Philippines, seeks an experienced Healthcare BPO Team Lead with prior authorization experience to lead a team handling prior authorization tasks. You will monitor performance, ensure accuracy and HIPAA compliance, collaborate with healthcare providers and insurers, troubleshoot escalations, and drive continuous process improvements.

This onsite role offers mentoring opportunities, regular progress reporting to senior management, and potential for professional growth

Qualifications

• At least 1 year as a Team Leader.
• At least 2 years in Healthcare BPO, preferably Prior Authorization.
• Strong knowledge of healthcare terminologies and RCM.
• Strong knowledge of prior authorization processes, including insurance protocols, medical coding and billing.
• Experience working with healthcare providers, insurers, and TPAs.
• Amenable to report onsite at Pasay.

Responsibilities

• Lead, mentor, and motivate a team of BPO associates on prior authorization tasks.
• Monitor performance for accuracy, compliance, and productivity.
• Oversee day-to-day prior authorization requests and approvals.
• Collaborate with providers and insurers to ensure smooth processing of requests.
• Identify opportunities for process improvements and implement best practices for efficiency.
• Maintain records and present performance reports to senior management.

Skills

Team Leadership

Prior Authorization

HIPAA Compliance

Regulatory knowledge

Job description

We are seeking an experienced and results-driven Healthcare BPO Team Lead with prior authorization experience to join our team. As a Team Lead, you will be responsible for overseeing a team of associates who handle prior authorization processes. Your leadership will ensure that the team meets performance goals, delivers high-quality service, and adheres to industry standards and regulations.

Key Responsibilities:

• Team Leadership:

  • Lead, mentor, and motivate a team of BPO associates working on prior authorization tasks.

  • Monitor and assess team performance to ensure accuracy, compliance, and productivity.

  • Provide guidance and support to team members in resolving issues and handling complex prior authorization cases.

  • Conduct regular team meetings and provide feedback to help improve team performance.

• Prior Authorization Management:

  • Oversee the day-to-day operations of prior authorization requests and approvals.

  • Ensure timely and accurate submission of prior authorization requests in line with healthcare regulations and company protocols.

  • Collaborate with healthcare providers, insurance companies, and clients to ensure smooth processing of requests.

  • Troubleshoot and resolve escalated issues related to prior authorization delays or denials.

• Process Improvement & Compliance:

  • Identify opportunities for process improvements and implement best practices for efficiency and effectiveness.

  • Ensure compliance with HIPAA regulations and other industry standards.

  • Stay up-to-date with changes in healthcare regulations related to prior authorization and implement necessary updates within the team.

• Reporting & Documentation:

  • Maintain accurate records of prior authorization requests, decisions, and outcomes.

  • Prepare and present performance reports to senior management, highlighting achievements, challenges, and solutions.

Requirements:

• At least 1 year experience as a Team Leader

• At least 2 years experience in Healthcare BPO preferably in Prior Authorization role

• Strong knowledge in Healthcare terminologies and RCM

• Strong knowledge of prior authorization processes, including insurance protocols, medical coding, and billing.

• Experience working with healthcare providers, insurance companies, and third-party administrators

• Amenable to report onsite at Pasay