Lead Pre Authorization Benefits Specialist

1002 Adventist Midwest Management Services; United States; On-site; USD 27,000 - 42,000; Full time

Job summary

UChicago Medicine AdventHealth is seeking a Training and Staff Development Specialist to design and implement continuous education programs for our oncology operations. You will organize workshops, monitor performance, and coach staff to enhance patient care and ensure regulatory compliance.

The role requires knowledge of healthcare processes, HIPAA, and strong communication. On-site duties include coordinating sessions and validating training completion within our hospital network.

Qualifications

• Mature judgement when interacting with patients, physicians, and insurance reps.
• Proficient in MS Office and basic database familiarity.
• Able to operate general office machines and organize work efficiently.
• Able to follow complex instructions with attention to detail.

Responsibilities

• Develops and implements ongoing training programs for staff.
• Organizes workshops, seminars, and ongoing education; tracks participation.
• Monitors team performance and provides feedback and coaching.
• Ensures staff are trained in patient care protocols and insurance processes.

Skills

Mature judgement

Microsoft Office

Communication skills

Multi-tasking

HIPAA compliance

Customer service

Education

Associate degree

High School Diploma

Tools

EMR system

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:

(Please click the link below to view work 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.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.