Lead Pre-Authorization Specialist

Overview

Assists in leading the daily activities of the Revenue Cycle Pre-Authorization to ensure high quality customer service and improve revenue cycle activities for prior authorizations, predeterminations, documentation, billing and claims. Understands regulatory and third party payer guidelines for various authorizations including but not limited to diagnostic testing, imaging, medications, and outpatient services, and billing. Reviews daily schedules to ensure that all areas of Pre-Authorization are appropriately staffed for volumes and activities. Assists with training and education of Pre Auth for new and existing staff members. Promotes cross training and assists with scheduling with other Patient Access leadership to accomplish cross training to enhance job function and responsibilities so that maximum flexibility within Patient Access is achieved. Assists as needed with Department Supervisor and Manager to coordinate and communicate process updates and flows with internal departments at Carle, and external departments when necessary, to ensure that Prior Authorizations are in place by the patient's service date to increase patient satisfaction, reimbursement to the organization, and problem resolution. Understands the organization's denials reduction efforts and goals, authorization claim error resolution, and serves as a SME (Subject Matter Expert) for Revenue Cycle operations for authorizations. Assists Supervisor and Manager on administrative tasks as assigned.

Qualifications

Education: High School Diploma or G.E.D ,

Work Experience

• 1 year experience in Customer Service, preferred in Front Line Healthcare

Responsibilities

Monitors daily activities of the Prior Authorization department to ensure quality and quantity of work is maintained, and information with ordering and performing departments regarding patient authorizations is properly communicated in a timely mannerHas full knowledge of department authorization scope and Patient Care leadership contacts, systems contacts, and can effectively communicate with themAssists supervisor or manager with properly orienting and training new and existing staff in operations and equipment, including operational or payer changes to authorization requirementsWith the sign off of the supervisor or manager, completes payroll edits to ensure accuracy of labor hours.Assists performing department audits to identify authorization errors and provides audit information to supervisor or managerAssigns and delegates tasks as needed in the absence of employees so workflow is maintainedPerforms high level of patient service and confidentiality from all areas of responsibility.Monitor day to day scheduling and functions of Prior Authorization department to ensure staff are assigned appropriately to ensure timely scheduling and/or authorization of patient services Assists supervisor or manager by modeling the way for The Carle Experience with accountability of expectations by mentoring, coaching, discipline, etc. Assists supervisor or manager in performing audits to identify authorization errors while providing feedback to employees (i.e. WQ audits, documentation audits, Voicecert/Pixcert audits) Assists with onboarding and training of new and existing staff in Prior Authorizations Adhere to all leadership expectations of the Carle Experience

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: ***email_hidden***.

Compensation And Benefits

The compensation range for this position is $23.05per hour - $38.49per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.