Lead, Network Prior Auth and Referral Specailist

St. Luke's University Health Network•Allentown, PA

1d•Onsite

About The Position

The Lead Financial Clearance Representative performs all of the job responsibilities of a Pre-Encounter Representative Level II. Responsible for the integrity of patient, financial and verification data obtained by staff and notification of deficiencies to staff and management. In the absence of management, the Lead will be the individual that staff/other departments will contact if there are questions or issues to resolve. Responsible to resolve when appropriate, notify management of the issue and/or escalate to management for resolution.

Requirements

Three (3) years healthcare experience in an outpatient department or business office with a hospital, physician’s office, or similar medical facility required.
Strong customer service skills with knowledge of health insurance coverage and plans.
Must have ability to work independently.
Computer experience required.

Nice To Haves

Bilingual preferred

Responsibilities

Responsible for the financial clearance of all scheduled patients by providing accurate and timely verification of all financial information and pre-certification/referral for all services to ensure proper reimbursement
Monitors all schedules to insure that all cases are identified and financial clearance is obtained.
Ensures that either pre-certifications or referrals are obtained prior to date of service (i.e. Surgery, diagnostic studies and infusion services).
Verifies benefits and coverage. Refers all self pay patients to the Financial Navigators for payment and accessibility options
Ensures CPT codes coordinate with testing and procedures that are ordered. Obtains retro authorizations and prepares appeals for denied services.
Updates and/or communicates correct patient information to appropriate staff, hospital departments, and computer systems
Identifies communication and procedural inefficiencies and/or breakdowns among staff and other departments or areas and assist in developing a correction plan. Provides information regarding process and reimbursement changes to providers, patients and other departments
Maintains ongoing knowledge of billing regulations and/or requirements and registration procedures
Serves as preceptor for all education in the department. Monitors and audits case record for appropriate resolution
Serves as “Go to” person for Supervisor and Manager during daily operations.