Precertification Team Lead: Payer Compliance & Access

Medical University of South Carolina; Charleston, Northern (SC, KY); Hybrid; USD 56,000 - 84,000; Full time

Benefits offered by this job

Health insurance

Employer Sponsored Retirement Plan

Paid time off and extended sick leave

Paid Parental Leave

Disability insurance plan options

Continuous professional and clinical培训

Competitive pay

Annual Merit Increase

Wellbeing resources

Tuition Reimbursement

Employee perks and discounts

Employee referral program

Flexible schedule options

Certification incentive program

Job summary

MUSC Community Physicians (MCP) is seeking a Precertification Specialist Team Lead who will oversee the preauthorization staff, ensuring timely, accurate, and compliant authorizations. This role acts as a subject matter expert for payer requirements and medical necessity guidelines.

Reporting to the Central Precert Unit Supervisor, you will lead daily operations, coach staff, and collaborate with providers and payers to support patient access and revenue integrity.

Qualifications

• Leadership and staff coaching to meet productivity and quality goals.
• In-depth knowledge of payer policies and medical necessity criteria.
• Experience with authorization processes and escalation handling.
• Ability to liaise between staff, providers, and payers.

Responsibilities

• Lead, mentor, and support preauthorization staff to meet productivity, quality, and turnaround time standards.
• Review, process, and oversee complex or high-risk authorization requests.
• Monitor KPIs and conduct audits to improve denial prevention and outcomes.
• Coordinate with clinical teams to obtain accurate documentation and ensure timely authorizations.
• Serve as main contact for providers and payers on authorization issues and updates.

Skills

Team Leadership

Staff Development

Preauthorization Expertise

Payer Policy Knowledge

Documentation in EHR

Job description

MUSC Community Physicians (MCP) is seeking a Precertification Specialist Team Lead who will oversee the preauthorization staff, ensuring timely, accurate, and compliant authorizations. This role acts as a subject matter expert for payer requirements and medical necessity guidelines.

Reporting to the Central Precert Unit Supervisor, you will lead daily operations, coach staff, and collaborate with providers and payers to support patient access and revenue integrity.