Precertification Lead: Authorization & Payer Policy Expert

MUSC Health; Charleston (SC); On-site; USD 34,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Parental Leave

Disability insurance

Tuition reimbursement

Flexible schedule

Employee referral program

Job summary

MUSC Community Physicians (MCP) is seeking a Precertification Specialist Team Lead to oversee the preauthorization team, ensuring timely, accurate, and compliant medical service authorizations. The role reports to the Central Precert Unit Supervisor and acts as a SME for payer requirements and medical necessity guidelines.

The Team Lead will provide leadership, coaching, and workflow coordination, serving as liaison between staff, providers, and payers to support 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 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

Job description

MUSC Community Physicians (MCP) is seeking a Precertification Specialist Team Lead to oversee the preauthorization team, ensuring timely, accurate, and compliant medical service authorizations. The role reports to the Central Precert Unit Supervisor and acts as a SME for payer requirements and medical necessity guidelines.

The Team Lead will provide leadership, coaching, and workflow coordination, serving as liaison between staff, providers, and payers to support patient access and revenue