Senior Pediatric Revenue & Authorization Lead

UCSF Health, AG; Emeryville (CA); Sur place; USD 120 000 - 160 000; Plein temps

Résumé du poste

The Pediatric Lead Revenue Analyst at UCSF Health independently manages the pediatric revenue cycle within CCS authorization, overseeing a team of 10+ staff and driving complex financial clearance across inpatient, NICU, outpatient, and ancillary services. The role supports high‑volume operations affecting substantial weekly DNB activity and payer negotiations.

You will analyze denial trends, coordinate authorizations with Medicare/Medicaid payers, ensure timely processing, and partner with

Qualifications

• Must understand healthcare eligibility and insurance verification.
• Knowledge of hospital/clinic registration, referrals, authorization and billing.
• Ability to interpret eligibility information and communicate requirements accurately.
• Strong customer service and interpersonal communication skills.
• Knowledge of CCS requirements, HIPAA, and regulatory standards.
• Experience with Medi-Cal and California public programs.
• Experience with pediatric patients and families.
• Experience with electronic health records and revenue-cycle systems.
• Knowledge of pediatric authorization requirements and coordinating across payers.

Responsabilités

• Lead a team of 10+ authorization staff with workflow distribution and quality assurance.
• Independently secure authorizations, resolve denials, and optimize reimbursements.
• Monitor denial trends and performance metrics; implement workflow improvements.
• Coordinate with clinical, administrative, and billing stakeholders to ensure timely processing.
• Communicate with management and practices leadership to provide updates and address issues.

Connaissances

Healthcare eligibility

Insurance verification

Registration & billing processes

Eligibility interpretation

Customer service

HIPAA compliance

Medi-Cal & public programs

Pediatric patient experience

Electronic health records

Prior authorization across payers

Formation

High School diploma or GED + 7 years experience

Bachelor's degree + 3+ years experience

Description du poste

The Pediatric Lead Revenue Analyst at UCSF Health independently manages the pediatric revenue cycle within CCS authorization, overseeing a team of 10+ staff and driving complex financial clearance across inpatient, NICU, outpatient, and ancillary services. The role supports high‑volume operations affecting substantial weekly DNB activity and payer negotiations.

You will analyze denial trends, coordinate authorizations with Medicare/Medicaid payers, ensure timely processing, and partner with