Manager, Network Prior Authorization Department

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

22d

About The Position

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Manager, Network Prior Authorization Services is responsible for monitoring and facilitating the referral and authorization processes of the department, coordinating day-to-day activities, including direction of the Network Prior Authorization and Referral Specialists.

Requirements

Minimum Associate’s degree OR at least 3 years of experience accepted in lieu of degree.
Minimum of 3 years of hospital or health care experience in admission, registration and scheduling, or business office environment required.
Knowledge of registration procedures, insurance processing and third party billing requirements.
PC experience required.
Competent in Microsoft office, Excel Power Point, and Word.
Must be able to work independently.
Computer experience required.

Responsibilities

Actively participates in quality improvement activities relating to the financial clearance and prior authorization process of all scheduled patients as outlined by the department policy and procedure manual or as instructed by the Network Director of the Prior Authorization Department
Responsible for monitoring the workflow and accuracy of financial clearance activities of all scheduled patients including patient information, financial payer sources, precertification/referral/authorization to ensure proper and timely reimbursement
Responsible for the training of the Experian Prior Authorization Module and continued building and maintaining of the Knowledge Base component
Provides leadership and support to front-line staff
Leads talent management activities to develop and cultivate future leaders
Responsible for overseeing the staff collection of point of service cash for all patients with high out of pocket expenses, or any amount if speaking with the patient
Responsible for continued ongoing efforts of successfully integrating prior authorization specialists duties that are referral work queue based into patient work queue-based processes allowing for job role alignment
Support staff in interactions with medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient’s medical record before completion of third-party prior authorizations
Develop an effective working relationship with external entities
Assist with the development and implementation of policies and procedures to ensure reimbursement of high-cost non- oncology infusion medications