Pre-Authorization Spec Lead Team C
 Carle Health | |
 United States, Illinois, Champaign | |
| 3310 Fields South Drive (Show on map) | |
 Dec 30, 2024 | |
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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 License/Certifications: Education: Other Knowledge/Skills: Customer service 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 manner Has full knowledge of department authorization scope and Patient Care leadership contacts, systems contacts, and can effectively communicate with them Assists supervisor or manager with properly orienting and training new and existing staff in operations and equipment, including operational or payer changes to authorization requirements With 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 manager Assigns and delegates tasks as needed in the absence of employees so workflow is maintained Performs 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 About Us Find it here. Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. 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. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. 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: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $22.75per hour - $37.99per 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. | |