Lead Pre Authorization Benefits Specialist

About the role

Our Promise To You Joining UChicago Medicine AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Address: 701 WINTHROP AVE, GLENDALE HEIGHTS, IL 60139.

Responsibilities

• Develops and implements ongoing training programs to keep staff updated on the latest practices and technologies.
• Organizes workshops, seminars, and ongoing education for staff development; tracking and recording staff participation.
• Monitors and evaluates team performance to identify areas for improvement.
• Provides feedback and coaching to enhance staff skills and efficiency.
• Conducts regular performance reviews and sets goals for team members.
• Ensures accurate and timely processing of orders.
• Trains staff on order management systems and procedures.
• Trains staff on insurance authorization processes and requirements.
• Monitors order workflows to identify and resolve any issues.
• Reviews clinical data such as patient pathology reports, imaging, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines.
• Responsible for communicating to service line partners when medical necessity is not met including review of journal articles, compendia and/or peer review to justify medical necessity approval.
• Monitors patient interactions to ensure high-quality care and adherence to standards.
• Ensures that all staff are trained in patient care protocols and procedures.
• Ensures that all necessary authorizations are obtained, including length of authorization; total number of visits; and/or units of medication prior to services provided.
• Addresses any patient care concerns or complaints promptly.
• Other duties as assigned.