Lead Pre Authorization Benefits Specialist

adventhealth; Glenoaks Country (CA); On-site; USD 26,000 - 43,000; Full time

Benefits offered by this job

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

Job summary

UChicago Medicine AdventHealth is seeking a healthcare operations professional to support oncology-related business processes. You will train staff, manage order workflows, and ensure proper insurance authorizations while maintaining high-quality patient care.

Ideal candidates have 2+ years in customer service and patient access, plus familiarity with EMR systems and medical terminology. This role offers day shifts and full-time hours in a clinical environment.

Qualifications

• 1+ year oncology operations experience in specialty pharmacy or insurance verification.
• 2+ years customer service experience.
• 2+ years direct patient access experience.
• 2+ years related experience.
• Must read/write/speak conversational English.

Responsibilities

• Develops and implements ongoing staff training programs.
• Organizes workshops and ongoing education for staff development and tracking participation.
• Monitors and evaluates team performance; provides coaching and feedback.
• Ensures accurate and timely processing of orders and insurance authorizations.
• Reviews clinical data and justifies medical necessity for approvals.
• Maintains high-quality patient care and adherence to standards.

Skills

Mature judgement

Microsoft Office

Office equipment

Multitasking

Communication

Adaptability

Attention to detail

HIPAA compliance

Customer service

Insurance knowledge

EMR system

Medical terminology

English proficiency

Education

Associate

High School Grad or Equiv

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 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.