Lead Precertification Specialist

MUSC Health; Charleston (SC); On-site; USD 39,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Employer Sponsored Retirement Plan

Paid time off

Paid Parental Leave

Disability insurance plan options

Continuous professional and clinical培训

Competitive pay

Annual Merit Increase

Wellbeing resources

Tuition Reimbursement

Employee referrals and discounts

Flexible schedule options

Certification incentive program

Job summary

MUSC Community Physicians (MCP) is seeking a Precertification Specialist Team Lead to oversee the preauthorization team, drive productivity and quality, and ensure compliant authorizations for medical services. The role acts as a subject matter expert on payer requirements and works closely with clinical teams to secure accurate documentation and timely approvals.

The Team Lead will mentor staff, manage workloads, monitor KPIs, and partner with leadership to optimize patient access and revenue

Responsibilities

• Lead, mentor, and support preauthorization staff to meet productivity, quality, and turnaround time standards
• Assign and prioritize workloads based on service urgency and payer requirement
• Serve as escalation point for complex, urgent, or denied authorization cases
• Assist with onboarding, training, and ongoing staff education
• Provide coaching, feedback, and performance input to management
• Review, process, and oversee complex or high-risk authorization requests
• Ensure compliance with payer policies, medical necessity criteria, and internal workflows
• Collaborate with clinical teams to obtain accurate and complete documentation
• Monitor authorization status to prevent delays in patient care or scheduled services
• Maintain accurate documentation in EHR and practice management systems
• Monitor KPIs including turnaround time, approval rates, and denial trends
• Conduct quality audits and provide corrective guidance to staff
• Identify root causes of denials and process gaps
• Support denial prevention strategies and appeals when needed
• Recommend and assist with process improvement initiatives
• Serve as primary point of contact for providers, payers, and internal departments regarding authorization issues
• Communicate payer updates, policy changes, and workflow expectations to staff
• Participate in meetings related to patient access, utilization management, and revenue cycle performance
• Escalate risks or delays to leadership in a timely manner
• Assist with reports related to productivity, quality, and authorization outcomes
• Support policy, procedure, and workflow documentation updates
• Perform other duties as assigned to support departmental goals

Job description

Job Description Summary

MUSC Community Physicians (MCP) is an entity within the Medical University of South Carolina that provides healthcare to patients within the rural health network throughout the state of South Carolina.

Job Description

The Precertification Specialist Team Lead reports to the Central Precert Unit Supervisor and oversees daily operations of the preauthorization team to ensure timely, accurate, and compliant authorization of medical services. This role provides leadership, coaching, and workflow coordination while serving as a subject matter expert for payer requirements, medical necessity guidelines, and authorization processes. The Team Lead acts as a liaison between staff, providers, and payers to support optimal patient access and revenue integrity.

Entity

MUSC Community Physicians (MCP)

Worker Type

Employee

Worker Sub-Type

Regular

Cost Center

CC004513 MCP - Revenue Cycle

Pay Rate Type

Hourly

Pay Grade

Health-22

Scheduled Weekly Hours

40

Responsibilities

• Team Leadership & Staff Development – 30%
• Lead, mentor, and support preauthorization staff to meet productivity, quality, and turnaround time standards
• Assign and prioritize workloads based on service urgency and payer requirement
• Serve as escalation point for complex, urgent, or denied authorization cases
• Assist with onboarding, training, and ongoing staff education
• Provide coaching, feedback, and performance input to management
• Preauthorization Processing & Oversight – 30%
• Review, process, and oversee complex or high-risk authorization requests
• Ensure compliance with payer policies, medical necessity criteria, and internal workflows
• Collaborate with clinical teams to obtain accurate and complete documentation
• Monitor authorization status to prevent delays in patient care or scheduled services
• Maintain accurate documentation in EHR and practice management systems
• Quality Assurance & Performance Monitoring – 20%
• Monitor key performance indicators (KPIs) including turnaround time, approval rates, and denial trends
• Conduct quality audits and provide corrective guidance to staff
• Identify root causes of denials and process gaps
• Support denial prevention strategies and appeals when needed
• Recommend and assist with process improvement initiatives
• Communication & Cross-Functional Collaboration – 15%
• Serve as primary point of contact for providers, payers, and internal departments regarding authorization issuesCommunicate payer updates, policy changes, and workflow expectations to staff
• Participate in meetings related to patient access, utilization management, and revenue cycle performance
• Escalate risks or delays to leadership in a timely manner
• Reporting & Administrative Support – 5%
• Assist with preparation of reports related to productivity, quality, and authorization outcomes
• Support policy, procedure, and workflow documentation updates
• Perform other duties as assigned to support departmental goals

Benefits

• Health, dental, vision, and life insurance
• Employer Sponsored Retirement Plan
• Paid time off and extended sick leave
• Paid Parental Leave
• Disability insurance plan options
• Continuous professional and clinical training
• Competitive pay
• Annual Merit Increase
• Wellbeing resources
• Tuition Reimbursement
• Employee perks and discounts
• Employee referral program
• Flexible schedule options
• Certification incentive program

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees