Team Lead - Charge Posting (Authorization)

Job Summary:

The Team Lead – The Team Lead will manage a team responsible for provider-side prior authorizations, including referral submissions, clinical assessment submissions, prior authorization requests, and follow-ups with payers. A core responsibility is daily communication with US Program Managers, Providers, Clinical Coordinators, and internal leadership to ensure seamless operations, timely approvals, and process alignment. Excellent communication and stakeholder management skills are essential.

Key Responsibilities:

Authorization & Referral Workflow Management

· Manage Referral Form Submission, Clinical Assessment Submission, and Authorization Request Submission on behalf of providers.

· Review supporting documents such as clinical notes, progress notes, lab reports, and imaging results to ensure medical necessity.

· Submit authorizations via payer portals

· Conduct follow-ups on pending or delayed authorizations through portals, fax, or phone.

· Update approved/denied authorizations in the system or task management system.

Communication & Stakeholder Interaction

· Communicate daily with US Program Managers regarding workflow updates, case clarifications, escalations, and status tracking.

· Interact with US providers, clinicians, nursing teams, and front-office staff to gather missing documents, clarify clinical information, or resolve issues.

· Participate in regular calls with US counterparts to review performance, discuss changes, and address operational concerns.

· Provide timely updates on authorizations, delays, and high-priority cases.

Team Leadership & Operations

· Lead a team of Authorization Specialists; provide coaching, performance feedback, and skill development.

· Allocate daily workload based on priority and case urgency.

· Monitor productivity, quality, and SLA performance.

· Conduct regular audits to ensure accuracy of submitted authorization cases.

· Maintain updated SOPs, process changes, payer guidelines, and workflow documentation.

· Handle escalations and complex payer-specific cases.

Process & Compliance

· Ensure compliance with provider guidelines, payer policies, and HIPAA requirements.

· Track TAT, approval rate, denial trends, and other operational metrics.

· Coordinate with quality teams for error reviews, root cause analysis, and corrective actions.

· Support onboarding of new clinics, specialties, or service lines.

Required Qualifications:

· Bachelor’s degree in Life Sciences, Nursing, Physiotherapy, Pharmacy, Healthcare Administration, or related fields.

· 4–6 years’ experience in Provider-side Authorization Management, Referral Management, or Pre-Cert workflows.

· Minimum 1–2 years team lead or supervisor experience.

· Strong knowledge of:

· Authorization requirements

· Payer policies (UHC, Aetna, Anthem, Cigna, Humana, Medicaid/Medicare)

· CPT/ICD coding basics

· Medical necessity documentation

· Excellent verbal and written communication skills (must interact with US teams daily).

· Proficiency in payer portals and provider EHRs

· Strong analytical and reporting skills.

Preferred Skills:

· Experience in multispecialty provider groups, hospitals, or ambulatory care centers.

· Awareness of US insurance plans: HMO, PPO, EPO, Medicare Advantage, Medicaid plans.

· Exposure to denial management for authorization-related rework.