Lead Coordinator, Benefits Eligibility and Prior Authorization

About the role

About Navista Lead Coordinator, Benefits Eligibility and Authorization We believe in the power of community oncology to support patients through their cancer journeys. As an oncology practice alliance comprised of more than 40 sites, Navista provides the support community practices need to fuel their growth—while maintaining their independence. What Revenue Cycle Management (RCM) Contributes To Cardinal Health Practice Operations Management oversees the business and administrative operations of medical practices. The Revenue Cycle Management manages a team focused on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero. Job Purpose The Team Lead for Benefits Eligibility and Authorization is responsible for overseeing the daily operations of the Eligibility and Authorization team while maintaining hands-on involvement in verifying and maintaining insurance coverage and obtaining authorization across all patient accounts for all lines of business. This role combines individual contributor responsibilities with leadership duties, including problem-solving, staff support, training, as well as presenting performance trends to the supervisor for performance management. The Team Lead guides team members through complex eligibility scenarios and provides expert guidance on prior authorizations for Medical Oncology, Radiation, and other Imaging therapies. This position communicates with patients and other departments regarding patient coverage, eligibility, and authorizations.

Responsibilities

• Provide daily workflow support and problem-solving assistance utilizing the SOP’s and reference documents for consistency and accuracy in response to Eligibility and Authorization coordinators through Teams chats, emails, and direct communication via teams calls.
• Respond to team member questions regarding policies, procedures, complex cases, and system-related issues in a timely and thorough manner
• Train and onboard new Eligibility and Authorization coordinators, ensuring they understand department processes, systems, and performance expectations
• Monitor and review team performance and productivity metrics on a regular basis, identifying trends, opportunities for improvement, and coaching needs
• Act as an escalation point for complex eligibility and authorization delays that require advanced problem-solving, ensuring prompt resolution
• Coordinate and communicate information required or requested by other internal teams or site stakeholders within 24 hours
• Oversee and provide expert guidance on prior authorizations for Medical Oncology, Radiation, Imaging therapies, and other high-risk denial medications, ensuring robust clinical documentation, payer-criteria alignment, proactive appeals management, and minimized treatment delays for vulnerable patient populations
• Maintain up-to-date knowledge of payer-specific requirements, including Medicaid, Medicare Advantage plans and various commercial insurance plans as well