Pre-Authorization Team Lead

　　Department: Registration Center - CFH1019

　　Entity: Champaign-Urbana Service Area

　　Job Category: Clerical/Admin

　　Employment Type: Full - Time

　　Job ID: 39850

　　Experience Required: 3 - 5 Years

　　Education Required: Associates Degree

　　Shift: Day

　　Location: Urbana, IL

　　Usual Schedule: 8a-5p

　　On Call Requirements: None

　　Work Location: Carle at The Fields

　　Weekend Requirements: As needed

　　Holiday Requirements: None

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　　Position Summary:

　　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:

　　EDUCATIONAL REQUIREMENTS Associate's Degree in Business, Healthcare or related field CERTIFICATION & LICENSURE REQUIREMENTS Certified Healthcare Access Associate (CHAA) within 2 years. EXPERIENCE REQUIREMENTS Two years relevant experience in customer service. Healthcare/prior authorization experience preferred.

　　Essential Functions:

　　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

　　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 protected].

　　Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.