Outpatient Utilization Specialist Lead - UH Truman Support Center - tiffany Springs (7:00am - 3:30pm)

Outpatient Utilization Specialist Lead

The Outpatient Utilization Specialist Lead can be the first point of contact for many patients into the Outpatient department, and many times, into Truman Medical Center. This position is responsible for providing a positive image to the patient and family. Ask key questions and correctly and rapidly facilitate the prior authorization and scheduling process for outpatient patients, by ensuring that authorization and patient financial requirements are met. Communicate financial responsibility to the scheduling personnel. Work with FCC Staff to ensure that discount and/or Medicaid information is accurate and, in cases of other commercial insurance, ensures that member information is accurate. Facilitate the flow of information between the clinical areas, insurance company and the Patient Accounting Department. Document all pertinent information in the appointment area of the order. Perform clerical work using various applications. This position serves as a resource for technical information and training of other Outpatient Utilization Specialists and Patient Account Representatives. In addition, the Outpatient Utilization Specialist Lead will be expected to identify process development or improvement for current on-going activities. Serves as a role model for current staff members and may act in the place of the Patient Account Supervisor, in their absence. Responsibilities may include generating regular reports to assist the Supervisor and or Manager of the department.

Minimum Requirements

• High school diploma or equivalent.
• Four years of experience in a healthcare setting. Including experience in a hospital business office, physician's office or insurance billing environment.
• Experience in healthcare insurance verification, billing protocols and pre-authorization.
• Must have computer literacy and math aptitude, and the ability to use 10-key calculator, computer key board and basic software applications, including Excel, Word and Outlook.
• Good Oral and written communication skills.
• Two years' experience in leading a team. Three years of experience doing pre-authorizations in a hospital setting may be used in lieu of team lead experience. Working knowledge of medical terminology, CPT codes, and ICD9 and ICD10 codes.
• Communication and customer service skills required to gather and exchange information with patients, families, hospital staff members, physicians and third party payers.
• Ability to work and think independently, ability to handle sensitive information, with discretion, attention to detail, ability to handle multi-tasking and change in priorities.

Preferred Qualifications

• Associates or Bachelor's Degree.
• A minimum of 4 years experience in authorization of outpatient procedures in a hospital setting.
• Course work in medical terminology and coding.