Lead Pre Authorization Benefits Specialist

AdventHealth; Glendale Heights (IL); On-site; USD 26,000 - 43,000; Full time

Benefits offered by this job

Benefits from Day One

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

On-site work

Equal opportunity employer

Job summary

UChicago Medicine AdventHealth in Glendale Heights, IL seeks an experienced operations professional to support oncology-related business processes. You will develop staff training, monitor performance, and ensure accurate order processing and insurance authorizations.

You will review clinical data, justify medical necessity, and maintain HIPAA compliance while delivering high-quality patient care and service-line coordination. The role is full-time, on-site, with day shifts.

Qualifications

• Minimum 1+ year oncology-related business operations experience.
• Familiarity with medical terminology and concepts.
• Experience with third-party insurance, payor reimbursement, and authorization submission.

Responsibilities

• Develops and implements ongoing staff training programs.
• Organizes workshops, seminars, and continuing education for staff development.
• Monitors and evaluates team performance and provides coaching.
• Conducts regular performance reviews and sets goals.
• Ensures accurate processing of orders and staff training on systems.
• Verifies insurance authorizations and monitors workflows for issues.
• Reviews clinical data and justifies medical necessity approvals when needed.
• Ensures compliance with patient care protocols and HIPAA requirements.

Skills

Mature judgement

MS Office

Professional communication

HIPAA compliance

Customer service

Insurance knowledge

EMR systems

Medical terminology

English fluency

Education

Associate degree

High School Grad or Equiv

Tools

EMR system

Database programs

Job description

Our promise to you:

Joining UChicago Medicine AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

701 WINTHROP AVE

City:

GLENDALE HEIGHTS

State:

Illinois

Postal Code:

60139

Job Description:

Develops and implements ongoing training programs to keep staff updated on the latest practices and technologies. Organizes workshops, seminars, and ongoing education for staff development; tracking and recording staff participation. Monitors and evaluates team performance to identify areas for improvement. Provides feedback and coaching to enhance staff skills and efficiency. Conducts regular performance reviews and sets goals for team members. Ensures accurate and timely processing of orders. Trains staff on order management systems and procedures. Trains staff on insurance authorization processes and requirements. Monitors order workflows to identify and resolve any issues. Reviews clinical data such as patient pathology reports, imaging, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines. Responsible for communicating to service line partners when medical necessity is not met including review of journal articles, compendia and/or peer review to justify medical necessity approval. Monitors patient interactions to ensure high-quality care and adherence to standards. Ensures that all staff are trained in patient care protocols and procedures. Ensures that all necessary authorizations are obtained, including length of authorization; total number of visits; and/or units of medication prior to services provided. Addresses any patient care concerns or complaints promptly. Other duties as assigned.

Knowledge, Skills, and Abilities:

• Mature judgement in dealing with patients, physicians, and insurance representatives [Required]
• Intermediate knowledge of Microsoft programs and familiarity with database programs [Required]
• Ability to operate general office machines such as computer, fax machine, printer, and scanner [Required]
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion [Required]
• Ability to communicate professionally and effectively, both verbally and written [Required]
• Ability to adapt in ever changing healthcare environment [Required]
• Ability to follow complex instructions and procedures, with a close attention to detail [Required]
• Adheres to government guidelines such as CMS, EMTALA, and HIPAA and AdventHealth corporate policies [Required]
• Exceptional customer service skills [Required]
• Advanced understanding of insurance knowledge and benefits [Required]
• Advanced understanding of hospital electronic medical record (EMR) system [Required]
• Basic medical terminology [Required]
• Must be able to read, write, and speak conversational English [Required]
• Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature as needed to perform duties [Preferred]
• Intermediate medical terminology [Preferred]

Education:

• Associate [Preferred]
• High School Grad or Equiv [Required]

Field of Study:

• Grad or Equivalent

Work Experience:

• 1+ year experience in oncology related business operations within specialty pharmacy or insurance verification, payor reimbursement guidelines, and/or authorization submission. familiarity with medical terminology and concepts. working knowledge with third party insurance administrators authorization and clinical care processes [Preferred]
• 2+ years of customer service experience [Preferred]
• 2+ years of direct patient access experience [Preferred]
• 2+ years of related experience [Required]
• Medical Assistant [Preferred]

Additional Information:

• N/A

Licenses and Certifications:

• Certified Healthcare Access Associate (CHAA) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements:

Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$19.26 - $30.81

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.