[Hiring] Authorization/Eligibility Team Lead @USHP

Role Description

The Authorization/Eligibility Team Lead oversees the daily operations of a team responsible for verifying patient insurance coverage, determining eligibility for services, and obtaining prior authorizations to ensure timely access to care. This role provides leadership, training, and support to team members while monitoring productivity, accuracy, and compliance with insurance requirements and organizational policies. The Team Lead works closely with insurance companies, healthcare providers, and internal departments to resolve authorization issues, reduce claim denials, improve workflows, and ensure efficient revenue cycle operations while maintaining excellent customer service and patient satisfaction.

• Oversee daily operations of the Authorization/Eligibility team, assign workloads, monitor performance, and ensure team members meet productivity and quality standards.
• Ensure patient insurance coverage, benefits, plan limitations, deductibles, copayments, and out-of-pocket responsibilities are verified accurately and timely.
• Oversee the submission, tracking, and follow-up of prior authorization requests to ensure services, procedures, or treatments are approved before scheduled appointments.
• Monitor daily work queues, prioritize urgent requests, manage pending authorizations, and ensure tasks are completed within established turnaround times.
• Train new employees, provide ongoing coaching, communicate policy updates, and support staff in improving accuracy, efficiency, and customer service.
• Resolve complex eligibility discrepancies, authorization denials, delayed approvals, and insurance-related issues by collaborating with insurance representatives, providers, and internal departments.
• Track key performance indicators, including productivity, authorization turnaround times, verification accuracy, pending requests, and denial trends. Prepare reports and recommend improvements.
• Work closely with scheduling, registration, billing, coding, clinical teams, and revenue cycle management to prevent delays in care and reduce claim denials.
• Communicate changes in insurance policies, authorization requirements, payer portals, and eligibility procedures to ensure the team remains informed and compliant.
• Assist with staffing coverage, schedule coordination, workload distribution, and attendance monitoring to maintain consistent departmental operations.
• Identify authorization and eligibility issues that could result in claim denials or delayed reimbursement and implement corrective actions to minimize financial impact.

Qualifications

• High school diploma or equivalent

Requirements

• Knowledge of medical billing and coding
• Knowledge of Utilization Management sites (i.e., eviCore, AIM, RadMD, Navinet)
• Proficient with NextGen Practice Management and EHR
• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Ability to prioritize tasks and to delegate them when appropriate
• Ability to function well in a high-paced and at times stressful environment
• Provides exceptional customer service to our patients
• Always exhibits professionalism and ethical behavior
• Maintains strict confidentiality of patient and business information
• Maintains OSHA and HIPAA regulations
• Works as part of the team and treats everyone with respect, courtesy, and friendliness
• Adheres to all policies and procedures of the organization
• Recommends improvements to policies and procedures to management
• Participates in committees, discussions, and other team functions

Preferred Qualifications

• Minimum of 2-3 years of current Authorization/Eligibility Verification experience

Physical Demands and Work Environment

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers to handle or feel, as well as talk and hear. The employee is regularly required to reach with hands and arms. The employee is required to stand and walk. The employee may lift and/or move up to 15 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EEO Statement

Cardiovascular Physicians of Delaware is an equal opportunity employer. Employment and processes, including decisions to hire, promote, discipline, or discharge, are based on merit, competence, performance, and business needs. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.

This job description may not be inclusive of all assigned duties, responsibilities, or aspects of the job described, and may be amended at any time at the sole discretion of the Employer.