Lead Precertification Specialist-Team Lead, Access & Revenue

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

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