Pre-Authorization Lead Job Purpose: Coordinates, leads and is accountable for the daily/weekly/monthly activities of the pre-authorization specialists. Ensures that pre-authorizations and benefits are obtained on a timely basis and documented in advance of appointments.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

• Coordinates, leads and is accountable for the daily activities of the pre-authorization team
• Oversees daily workflow for all upcoming office visits and procedures involving the pre-authorization team
• Responsible for ensuring all pre-authorizations are obtained for scheduled office visits and outpatient procedures
• Answers prior authorization inquiry calls and/or faxes
• Oversees training, assistance and in-service to staff members
• Researches formulary and benefit issues using the appropriate reference material
• Resolves issues and complaints in a timely manner
• Handles inbound phone requests and gathers patient data to provide information for upcoming services
• Provides feedback for problem resolution for pre-authorization denials, and ensures compliance with state and federal guidelines
• Maintains dictation audit to ensure all dictations have been completed and received
• Makes provider aware of any missed dictation immediately
• Ensures fax documents and correspondence are distributed
• Responsible for calling patients with high deductibles and coinsurance prior to appointment
• Maintains patient confidentiality
• Presents a professional image and customer focus
• Practices teamwork by helping others willingly and communicating in a professional manner
• Updates job knowledge by participating in educational opportunities; reading professional publications
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
• Has regular and predictable attendance
• Adheres to company policies and procedures
• Performs other duties as assigned

SUPERVISION Reports to Business Office Manager

MINIMUM QUALIFICATIIONS

Education:

• Associate's and/or Bachelor's degree preferred

Experience:

• Minimum of 5 years of experience in the medical field, with at least one year experience obtaining and verifying pre-authorizations with various Managed Care companies.
• One or more years’ experience in a healthcare environment supervisory role.
• Billing/coding experience preferred.

WORKING CONDITIONS

Environmental Conditions: Medical Office environment

Physical Conditions:

• Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
• Must be able to sit and/or stand for prolonged periods of time
• Must be able to bend, stoop and stretch
• Must be able to lift and move boxes and other items weighing up to 30 pounds.
• Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

KNOWLEDGE, SKILLS AND ABILITIES:

• Protects patient information and maintains confidentiality
• Excellent leadership skills

• Must be able to maintain a tactful demeanor at all times
• Strong verbal and written communication skills
• Well-organized and detail-oriented
• Ability to work in a fast paced environment
• Ability to solve problems in an effective manner
• Team player and positive attitude
• Demonstrated knowledge of Microsoft Excel including, but not limited to, creation and formatting spreadsheets
• Knowledge of medical terminology, including pain management procedures and familiarity with Electronic Medical Records
• Must possess outstanding customer services skills