Hybrid Prior Authorization and Referral Team Lead - Greenville, SC

Assists with operations of the Eligibility and Benefits department, encompassing eligibility, patient benefits, proper insurance identification, use of payor portals, and clearing house rejections.

Acts as the first line for day-to-day questions, guidance training regarding insurance verification, plan code selections, authorization, and referrals.

Ensures that the activities of the Eligibility and Benefits department are conducted in a manner that is consistent with overall department protocol, and follow Federal, State, and payer regulations, guidelines, and requirements.

Analyzes trends impacting eligibility team and takes appropriate action.

Maintains insurance guide resources and provides guidance when needed to support insurance Masterfile maintenance

Keep up to date with carrier rule changes and distribute the information within the practice.

Conducts performance reviews for all direct reports.

Assists with development of Eligibility and Benefits office policies and procedures.

Troubleshooting patient billing complaints, develops process improvements to prevent recurrences.

Supervises staff, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.

Proven leadership and management skills

Serves as the subject matter expert and go to person for eligibility processes

Demonstrated analytic, written, and oral communication skills.

Takes initiative and daily decision making.

Responsible for specific team training and development of team members, providing feedback and monitoring.

Prepares reports for various departments pertaining to eligibility and benefits.

Supports leadership in oversight of designated Revenue Cycle Management to ensure all RCM functions are worked within the established timeframes.

Ensures that quality of work is maintained, and that compliance policies and procedures are followed through billing operations.

Conduct team meetings to educate on insurance guidelines, claim denials pertaining to department, and re-training efforts on accounts incorrectly verified, charges non submitted.

Maintain patient confidentiality and function within the guidelines of HIPAA.

Provide resolution support and guidance surrounding all billing processes and the performance management of all direct reports.

Ensure adherence to healthcare law, rules, and regulations.

Performs other miscellaneous duties as assigned pertaining to job level