Lead Coordinator, Benefits Eligibility and Prior Authorization

Cardinal Health

2d•$23 - $29

About The Position

The Team Lead for Benefits Eligibility and Authorization is responsible for overseeing the daily operations of the Eligibility and Authorization team while maintaining hands-on involvement in verifying and maintaining insurance coverage and obtaining authorization across all patient accounts for all lines of business. This role combines individual contributor responsibilities with leadership duties, including problem-solving, staff support, training, as well as presenting performance trends to the supervisor for performance management. The Team Lead guides team members through complex eligibility scenarios and provides expert guidance on prior authorizations for Medical Oncology, Radiation, and other Imaging therapies. This position communicates with patients and other departments regarding patient coverage, eligibility, and authorizations.

Requirements

Minimum four years of experience in a medical business office.
Knowledge of medical terminology.
Familiar with Urology, Chemotherapy, PET, and Radiation Billing.
Experience with computerized billing software and interpreting EOBs.
Working knowledge of ICD-10, CPT, HCPCS, and CPT coding.
Knowledge of computer/telephony support, preferably in a healthcare environment.
Strong customer service background, preferably in a healthcare environment.
Competence with computer processing functions and other standard office equipment.
Prior experience in Microsoft Office Suite.
Ability to manage and prioritize multiple tasks.
Ability to calmly and professionally resolve customer issues with diplomacy and tact.
Ability to work independently with minimal supervision.
Strong organizational skills.

Nice To Haves

4-5 years of experience, preferred

Responsibilities

Provide daily workflow support and problem-solving assistance utilizing the SOP’s and reference documents for consistency and accuracy in response to Eligibility and Authorization coordinators through Teams chats, emails, and direct communication via teams calls.
Respond to team member questions regarding policies, procedures, complex cases, and system-related issues in a timely and thorough manner
Train and onboard new Eligibility and Authorization coordinators, ensuring they understand department processes, systems, and performance expectations
Monitor and review team performance and productivity metrics on a regular basis, identifying trends, opportunities for improvement, and coaching needs
Act as an escalation point for complex eligibility and authorization delays that require advanced problem-solving, ensuring prompt resolution
Coordinate and communicate information required or requested by other internal teams or site stakeholders within 24 hours
Oversee and provide expert guidance on prior authorizations for Medical Oncology, Radiation, Imaging therapies, and other high-risk denial medications, ensuring robust clinical documentation, payer-criteria alignment, proactive appeals management, and minimized treatment delays for vulnerable patient populations
Maintain up-to-date knowledge of payer-specific requirements, including Medicaid, Medicare Advantage plans and various commercial insurance plans as well as notify Benefits Eligibility and Authorization Management of any issues that have potential for a negative outcome for the organization.
Demonstrates exceptional analytical and problem-solving abilities with a strong focus on accuracy and precision.
Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided, claims can be processed accurately and timely payment received.
Maintain excellent customer service and kindness with all patients and staff.
Maintain a high level of confidentiality for patients in accordance with HIPAA standards.
Regular attendance and punctuality.
Execute all functions of the role with positivity and team effort by accomplishing related results as needed.
Effectively completes other duties and projects assigned.