Supervisor, Network Prior Authorization Department

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.

JOB DUTIES AND 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.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting up to eight (8) hours per day, three hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision.

EDUCATION:

Minimum Associate’s degree or 6 years of paraprofessional experience accepted in lieu of degree.

TRAINING AND EXPERIENCE:

Three years experience in a hospital or healthcare facility finance, registration or admitting department. Must be able to work independently. Computer experience required.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.