What are the responsibilities and job description for the Prior Authorization Team Lead De La Pena Eye Clinic Commerce position at TPR/CPM Staff?
Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Tenet Physician Resources, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.
At Tenet Physician Resources, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
Note: Eligibility for benefits may vary by location and is determined by employment status
- Assist with organizing and assigning daily workflow within the team.
- Read and evaluate authorization reports and identify trends.
- Ensure compliance of all rules and regulations of insurance carriers.
- Ensure all authorizations are processed timely and accurately.
- Work closely with the Patient Communication Manager to ensure timely authorization requests and approvals.
- Identify and create solutions to problems relating to the timely processing of prior authorizations.
- Monitor authorizations request for accurate insurance coding and timely processing.
- Respond to patient account inquiries, questions, and complaints when necessary.
The Prior Authorization Team Lead is actively involved in assisting the Patient Communication Manager with problem solving and conflict resolution with team members, customers, and insurance companies. Under the direct supervision of the Patient Communication Manager this position requires assisting with a high level of timely, accurate, and complete analysis and oversight of the prior authorizations department from the insurance companies, facility programs and the patients, as well as the protection from loss of revenue. The Prior Authorization Team Lead is responsible for working co-operatively in a team setting, promoting team spirit and generating ideas that will develop the team and the Practice. The employee will adhere to and comply with the Covenant Code of Conduct, Human Resource Policies and Procedures, Operational Policy and Procedure Manual, Patient Bill of Rights, HIPAA compliance, and Corporate Compliance Plan.
EDUCATION AND/OR EXPERIENCE
- High School Diploma or equivalent.
- 5 years of successful prior authorization experience.
- Experience with practice management systems and clearinghouses; G-Med experience preferred.
Tenet Healthcare/TPR complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
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2503033690 Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship- Assist with organizing and assigning daily workflow within the team.
- Read and evaluate authorization reports and identify trends.
- Ensure compliance of all rules and regulations of insurance carriers.
- Ensure all authorizations are processed timely and accurately.
- Work closely with the Patient Communication Manager to ensure timely authorization requests and approvals.
- Identify and create solutions to problems relating to the timely processing of prior authorizations.
- Monitor authorizations request for accurate insurance coding and timely processing.
- Respond to patient account inquiries, questions, and complaints when necessary.
EDUCATION AND/OR EXPERIENCE
- High School Diploma or equivalent.
- 5 years of successful prior authorization experience.
- Experience with practice management systems and clearinghouses; G-Med experience preferred.
Tenet Healthcare/TPR complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
#LI-MS3
