Lead Pre-certification Specialist

Summary: The Pre-certification Lead assists the Revenue Cycle Manager with daily management of pre-certification staff, auditing functions, and assuring that all staff provides a level of patient care that meets or exceeds the organization’s expectations. The Lead pre-certification specialist is responsible for obtaining prior authorizations for all procedural and ancillary orders by successfully completing the authorization process with all required payers.
Job Duties:

• Assist with monitoring of pre-certification process to assure patient care standards are met by all pre-certification staff
• Perform all duties of assistant, coordinator, and specialist
• Act as a subject-matter expert for pre-certification
• Primary interface with administrators and medical directors on issues impacting authorization
• Monitors workload and compliance
• Address issues and works with supervisors to re-balance workloads to maintain regulatory compliance and service levels
• Complete assigned tasks accurately and within specified time limits
• Handle employee referrals
• Maintain smooth working relations with co-workers and supervisors.
• Understand all Pratt Regional Medical Center policies and procedures to help create and maintain job aides that are consistent with these policies
• Identify gaps in staff training and schedule ongoing training sessions to validate knowledge and understanding of payer requirements
• Assists with auditing to verify that all skills are executed properly and within specifications
• Anticipate our provider’s needs: Understands their wants and needs, listen for cues and identify how to respond and what level of intervention they need
• Return phone calls to providers and follow up with requests in a timely fashion
• Work in collaboration with other Team Leads to assist with daily operations, assuring a level of referral processing that meets or exceeds the organization’s expectation
• Recognizes when an error has been made and immediately reports it to the Manager
• Maintains quality monitors as assigned by Supervisor
• Treats coworkers and customers with patience and respect
• Assists other staff and supports the team approach
• Arrives to work on time. Consistently be at work. Display flexibility regarding lunches, breaks, and work hours to serve our customer’s needs
• Adheres to PRMC's Standards of Performance at all times.

Compensation & Benefits: Competitive wages and excellent fringe benefit program. Salary commensurate with experience.

Job Type: Full-time