Senior Pediatric Revenue Lead — Authorization

UCSF Health; Emeryville (CA); Hybride; USD 100 000 - 130 000; Plein temps

Résumé du poste

UCSF Health in Emeryville seeks a Lead Revenue Analyst to lead the CCS Authorization unit and oversee complex financial clearance for pediatric services across inpatient, NICU, outpatient, and ancillary care.

This role requires advanced revenue-cycle knowledge, coordination of prior authorizations across public and commercial payers, and strong collaboration with clinical/billing teams to ensure timely authorizations and optimized reimbursement. Onsite two days per week as needed.

Qualifications

• High School diploma or GED with seven years of relevant work experience, OR a Bachelor's degree with three or more years of relevant work experience.
• Knowledge of healthcare eligibility and insurance verification processes.
• Understanding of hospital and outpatient clinic registration, referral, authorization, and billing processes.
• Ability to interpret eligibility information and communicate requirements accurately.
• Strong customer service and interpersonal communication skills.
• Knowledge of compliance with CCS requirements, HIPAA, and applicable regulatory standards.
• Experience with Medi-Cal and other California public healthcare programs.
• Experience working with pediatric patients and their families.
• Experience with electronic health records and hospital registration or revenue-cycle systems.
• Demonstrates knowledge of pediatric authorization requirements and processes, with experience navigating diverse insurance plans and coordinating prior authorizations across payers, including Medicaid and other public insurance programs.
• The ability to work onsite two days a week or when required in Emeryville.

Responsabilités

• Lead a team of approximately 10–15+ authorization staff, including workflow distribution and productivity monitoring.
• Coordinate and resolve complex authorization issues to sustain a positive financial outcome.
• Secure routine and elective services within established timelines and manage urgent cases.
• Review medical documentation and coordinate peer-to-peer reviews and LOAs, PAFRs, and other clearance activities.
• Monitor denial trends and queue activity to identify workflow improvements and reduce denials.
• Communicate performance updates to management and practice leadership.

Connaissances

Healthcare eligibility

Insurance verification

Customer service

Communication skills

Analytical skills

Onsite collaboration

Formation

Bachelor's degree

High School diploma or GED

Outils

Electronic Health Records

Revenue-cycle systems

Description du poste

UCSF Health in Emeryville seeks a Lead Revenue Analyst to lead the CCS Authorization unit and oversee complex financial clearance for pediatric services across inpatient, NICU, outpatient, and ancillary care.

This role requires advanced revenue-cycle knowledge, coordination of prior authorizations across public and commercial payers, and strong collaboration with clinical/billing teams to ensure timely authorizations and optimized reimbursement. Onsite two days per week as needed.