Pre-Certification Team Leader

Overview

The Pre-Certification Team Leader oversees the daily operations of the Pre-Certification team to ensure timely and accurate insurance authorizations for scheduled services. This position plays a key role in minimizing denials and delays by ensuring payer requirements are met and by improving communication with provider offices. The role supports operational performance, staff development, and compliance.

Responsibilities

 

Lead daily operations of the pre-certification team and provide real-time support and escalation for issues.

Train, mentor, and support staff on payer guidelines and internal processes.

Ensure authorizations are completed timely, accurately, and in compliance with payer requirements.

Communicate with physician offices regarding authorization issues and delays.

Alert providers and patients when procedures must be rescheduled due to pending or denied authorizations.

Review work queues and productivity metrics to ensure performance standards are met.

Cross-train staff to cover imaging, hospital admissions, and other pre-cert functions.

Maintain accurate documentation of authorizations in registration and scheduling systems.

Resolve escalated or complex cases.

Participate in root cause analysis of denials and initiate improvements.

Support VIM customer service and maintain a patient-first approach.

Assist with hiring, onboarding, and performance feedback.

 

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Qualifications

High school diploma or equivalent required; associate’s or bachelor’s degree preferred.

Minimum 1 year in healthcare registration or insurance authorization.

Experience with payer portals and authorization workflows.

Strong organizational and problem-solving skills.

Clear communication with providers, patients, and teams.

Familiarity with HIPAA, insurance, and pre-certification processes.

 

WORKING CONDITIONS

 

WORK CONTEXT

Communication through talking, expressing and exchanging ideas by means of the spoken word.  Hearing; perceiving the nature of sounds by the ear in order to communicate.  Seeing; use of vision to determine characteristics of objects, depth perception, color vision with the ability to distinguish color, coding on ledgers, near/far activity 100% daily.

Ability to figure complex computations and communicate these figures to the public.

Mental capability to maintain patient confidentiality 100% of the time.

 

PHYSICAL FACTORS

Working indoors in a cubical area, sitting 80% of the time, standing 5%, kneeling 2.5%, squatting/crouching 2.5%, stooping 5%, and walking 5%.  Activities include lifting of 35 lbs maximum which would be a two (2) man lift, frequent lifting and/or carrying 20 lbs. occasionally.  Ability to push or pull over carpet floors, concrete ramps and on varied surfaces, a four wheel cart with 50 lbs. of paperwork.

Filing ledgers or finding ledgers requires reaching, pushing, pulling, extending the hands and arms in any direction.  Stooping and bending the body forward by bending the spine at the waist.  To reach lower areas requires kneeling by bending the legs at the knee of crouching by bending the body downward and/or forward by bending the legs and spine.  This is 50% of daily work.

• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.
• Physical presence onsite is essential.

OTHER JOB FACTORS

• Excellent conflict resolution and customer service abilities.
• Leadership and Team Support
• Operation Management
• Customer Ser