Lead Pre-Service / Pre-Certification Specialist

The Lead Pre-Certification Specialist is responsible for overseeing the team of specialists who handle the pre-authorization request on behalf of physician practices that are registered with the AMI Pre-Authorization Service.

This role involves managing the day-to-day operations of the team, ensuring that pre-authorizations are obtained in a timely and accurate manner, and resolving any issues or escalations that may arise during the process.

The Lead is also responsible for training and coaching team members, monitoring performance metrics, and implementing process improvements to optimize efficiency and quality of service. Effective communication skills, attention to detail, and a strong understanding of radiology procedures and insurance requirements are essential.

AMI offers a generous compensation and benefits package including medical, prescription, dental, vision, flexible spending accounts, Paid Time Off (PTO), 401k and profit sharing and the opportunity to work in an exciting and progressive outpatient practice!

The Lead Pre-Certification Specialist will be responsible for, but not limited to:

• Serves as principal contact for Atlantic Medical Imaging and pre-authorization department staff regarding prior authorization processes for services to be rendered at all AMI locations.
• Advises referring providers and their clinical staff of issues that may arise relating to obtaining pre-authorization.
• Maintains a current knowledge base related to insurance requirements for pre-authorization. Serves as primary resource on pre-authorization requirements.
• Works closely on implementation and maintenance of pre-authorization platform (e.g., Gravity).
• Collaborates with clinical staff and billing on issues related to prior authorization and reimbursement issues.
• Communicates often with Marketing Director to monitor daily workflows.
• Trains new department employees and alerts the APS team of any changes in current workflows or processes.
• Works with Marketing Director to develop quality control measures. Implement appropriate measures. Monitors program area performance focusing on accuracy, timeliness, productivity, etc.
• Monitors productivity to optimize utilization of staff resources, including monitoring staff working from home.
• Confirms that workload is distributed in a fair and balanced manner throughout the department and rotates assignments if necessary.
• Completes payroll weekly and approves or denies PTO requests. Maintains Time Off calendar to ensure appropriate coverage is provided. Assigns APS team members to worklists requiring additional support.
• Perform other duties, as assigned.
  
  

The work schedule for this remote position includes day shifts Monday-Friday. Candidates must be willing to travel on-site to the Corporate Headquarters in West Atlantic City, NJ, or other regional offices, as needed for meetings. Training for the position will be completed on-site. Schedules and locations are subject to change based on business or department needs.

Candidates must have a high school diploma or equivalent. Prior leadership experience is required. At least two (2) years of professional work experience in Pre-Authorization processes is required. Medical terminology, insurance knowledge, and experience working with Referring Physicians is required for success in this position. Qualified candidates must demonstrate proficiency and familiarity with EviCore, NaviNet, insurance platforms, EMR, and the Microsoft Office Suite.

Candidates must possess leadership qualities and demonstrate the ability to lead by example in terms of communication, service, and work quality. Exceptional verbal and written communication are required for success in this position. Candidates must be willing to occasionally work on-site when required, to attend meetings and training.

EOE