Koya is always looking for curious and passionate individuals who want to join a fast- paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.
Description
Job Summary
The Prior Authorization Team Lead supports the daily operations of the prior authorization team, ensuring timely and accurate processing of authorization requests, and maintaining compliance with payer and regulatory requirements. This role serves as a subject matter expert, supports staff development, and drives process improvements to enhance efficiency and patient care outcomes. This opportunity is ideal for a high-performing individual who can manage additional responsibilities while consistently
maintaining daily performance expectations
This role reports to the Prior Authorization Manager within the Reimbursement
Operations Department. The role is full time, exempt and will work remotely.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
● Serve as the first‑line resource for Prior Authorization Specialists regarding payer
requirements, workflow questions, and complex or escalated cases.
● Support onboarding and training of new Prior Authorization Specialists, including
shadowing, competency checks, and reinforcement of best practices.
● Identify workflow gaps, recurring issues, or payer‑specific challenges and escalate
recommendations for process improvement.
● Partner with the Prior Authorization Manager to track team performance metrics and contribute to performance evaluations.
● Achieve monthly quality and productivity benchmarks.
● Submit medical records and documentation to payers for coverage approval, including network exceptions and single case agreements.
● Process authorizations, precertifications, predeterminations, and referrals across
multiple health insurance plans.
● Educate payers on product features and benefits to support coverage and
reimbursement.
● Communicate payer process findings clearly to internal stakeholders.
● Collaborate with internal departments to ensure accurate patient order processing.
● Maintain compliance with HIPAA and all regulatory requirements.
● Ensure accuracy while meeting productivity and quality standards.
● Assist in developing internal workflows and best practices.
Minimum Qualifications
Education, Experience and Training
● High school diploma required; Associate’s or Bachelor’s degree preferred
● Minimum 3 years of experience in prior authorization and reimbursement processes
● Background in medical devices, healthcare reimbursement, or related field
Knowledge, Skills and Abilities
● Strong understanding of insurance processes and authorization workflows
● Strong leadership and team development skills
● Excellent written and verbal communication skills
● High attention to detail with strong organizational and multitasking skills
● Ability to work independently and collaboratively in a fast-paced environment
● Proficient in navigating payer portals and Salesforce
Core Competencies
● Peer Relationships
● Problem Solving
● Time Management
● Drive for Results
● Initiative & critical thinking
● Flexibility & adaptability
● Planning & organization
● Teamwork & collaboration
Tools and Technology
Google Suite, Microsoft Office Suite, Adobe, Salesforce CRM
Physical Functions and Work Environment
The physical functions described here are representative of those that must be met by
an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
While performing the duties of this position, the employee is regularly required to talk or
hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Note
This job description in no way states or implies that these are the only duties to be
performed by the employee(s) incumbent in this position. Employees will be required to
follow any other job-related instructions and to perform any other job-related duties
requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.
Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
About the Company
Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy.
Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun.
We offer a base + bonus compensation package, and a competitive benefits program.