Supervisor, Network Prior Authorization Department

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

23h

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 Supervisor, Network Prior Authorization Services is responsible for monitoring and facilitating the Financial Clearance process of the Pre-Encounter Center, coordinating day-to day activities, including direction of the Pre-Encounter and Prior Authorization representatives. This individual will ensure all assigned department work queues are monitored and worked daily.

Requirements

Minimum Associate’s degree or 6 years of paraprofessional experience accepted in lieu of degree.
Three years experience in a hospital or healthcare facility finance, registration or admitting department.
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 Manger of the Pre-Encounter Center
Responsible for monitoring the work flow and accuracy of financial clearance activities of all scheduled patients including patient information, financial payer sources, pre-certification/referral/authorization to ensure proper and timely reimbursement
Assigns tasks to staff and ensures that all financial clearance areas are covered appropriately by daily review and verification of staff assignments and managing work flow.
Monitors patient schedules to ensure that all cases are identified and financial clearance is obtained.
Perform account audits and daily checks for accurate referral and authorization reference numbers and codes
Updates and communicates with physician, technical, hospital, and billing departments for any schedule, insurance, clinical changes or corrections to patient accounts
Monitors denial WQs to identify trends in errors, procedure changes, physician compliance and ensures timely appeals/retro authorization requests are completed by financial clearance staff
Effectively serves as liaison with scheduling and billing offices to correct and/or resolve any account issues or errors
Seeks out and participates in ongoing education and training related to government regulations, payer changes and requirements with new technology affecting the registration and billing processes
Informs staff of changes in hospital policies and procedures so staff is able to effectively gather accurate patient, medical and financial information.
Assists in maintaining current work schedules and vacation requests, making sure all shifts are covered.
Accurately monitors Kronos time reporting.
Provides training, education and continued mentoring support of Pre-Encounter Staff.