The
Healthcare Lead oversees the day-to-day operations of
pre-certification, prior authorization, scheduling, and related patient access functions. The role ensures timely, accurate, and compliant processing of healthcare services while supporting appointment readiness and minimizing authorization-related delays and denials.
The Lead provides guidance and operational leadership to team members, monitors performance and quality, manages escalations, and works closely with clinical teams, providers, payers, scheduling, and leadership to maintain efficient healthcare workflows.
Key Responsibilities
- Oversee daily pre-certification, prior authorization, and scheduling workflows.
- Monitor team productivity, quality, turnaround times, accuracy, and service levels.
- Provide coaching, guidance, and performance support to team members.
- Handle escalated authorization, payer, scheduling, and patient access issues.
- Ensure accurate documentation of authorization and scheduling activities in EHR and related systems.
- Coordinate with clinical teams, providers, payers, and front-end staff to prevent delays and appointment cancellations.
- Ensure compliance with payer requirements, medical necessity guidelines, and organizational policies.
- Maintain and improve SOPs, workflows, and operational guidelines.
- Identify process gaps and implement improvements to reduce delays, rework, and denials.
- Support staffing, workload allocation, training, and team performance activities.
- Prepare operational reports and communicate performance updates and concerns to leadership.
- Support implementation, transition, and process improvement initiatives as needed.
Qualifications
- Bachelor's degree in Healthcare Management, Business Administration, Nursing, or related field preferred.
- Minimum 3–5 years of healthcare experience in pre-certification, prior authorization, scheduling, patient access, insurance verification, or related functions.
- At least 2 years of leadership, team lead, supervisory, or workflow coordination experience.
- Strong knowledge of insurance authorization, payer requirements, and healthcare workflows.
- Familiarity with CPT, ICD-10, medical terminology, EHR systems, payer portals, and authorization platforms.
- Strong communication, analytical, organizational, and problem-solving skills.
- Ability to manage high-volume workflows and multiple priorities in a fast-paced healthcare environment.
CORE COMPETENCIES
- Healthcare Operations
- Pre-Certification & Prior Authorization
- Scheduling & Patient Access
- Team Leadership
- Performance Management
- Quality & Compliance
- Process Improvement
- Stakeholder Management
- Escalation & Problem Solving
