Job Description

The Lead Benefits and Authorization Specialist serves as the department subject matter expert and team lead for insurance verification and prior authorization functions. This position is responsible for overseeing daily authorization and benefits workflows, ensuring accuracy and timeliness of work completed by team members, and serving as a resource for complex payer requirements and authorization issues. The Lead Benefits and Authorization Specialist works closely with Scheduling, Clinical Operations, Surgical Coordinators, Billing, and Revenue Cycle Leadership to improve authorization accuracy, reduce denials, and support revenue cycle performance. The Lead maintains individual productivity while providing guidance, training, quality review, and workflow oversight for the Benefits and Authorization team.

Essential Functions

• Serve as the primary resource for Benefits and Authorization Specialists and provide day-to-day guidance and support.
• Assist with onboarding and training of new team members.
• Monitor departmental work queues to ensure insurance verification and authorization requests are completed timely.
• Review work for accuracy and provide coaching opportunities as needed.
• Escalate payer issues, authorization delays, and workflow concerns to the RCM Director.
• Assist with development and maintenance of departmental policies and procedures.
• Promote collaboration between Revenue Cycle, Clinical Operations, Scheduling, Surgery Scheduling, and other departments.
• Verify patient insurance eligibility and benefits for scheduled appointments and procedures.
• Confirm coverage details including deductibles, co-pays, coinsurance, and out-of-pocket maximums.

Education and/or experience

• High school diploma or equivalent required; Associate's degree preferred.
• Minimum 4-5 years of experience in medical billing, benefits verification, or authorization management.
• Minimum 1-2 years of healthcare leadership, lead, mentoring, or supervisory experience preferred.
• Strong knowledge of medical insurance plans including commercial, Medicare, Medicaid, and Tricare.
• Advanced understanding of prior authorization requirements and payer policies.
• Familiarity with medical terminology and CPT/ICD-10 codes.
• Experience with practice management systems and EHR platforms.
• Strong knowledge of medical coding, third-party payer processes, and revenue cycle operations.
• Excellent communication and customer service skills.
• Proficiency with Microsoft Office applications, including Word and Excel.
• Strong written and verbal communication skills.
• Excellent organizational, analytical, and problem-solving abilities.
• Ability to manage multiple priorities while maintaining a high level of accuracy.
• Demonstrated ability to work collaboratively and effectively with multidisciplinary teams.
• Must be responsible, reliable, and able to independently carry out job functions.

Total Rewards
The referenced base salary range represents the low and high end of Chesapeake Specialty Care salary range for this position.Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications.