Description
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Summary:
The Pre- Arrival Authorization Specialist I will serve patients/customers and physician offices by obtaining authorizations from insurance payers prior to services been scheduled or rendered at UNC Health Wayne for outpatient & inpatient visits. Obtains insurance information that will be verified via websites, telephone, or the Electronic Health Record (EHR). Electronic referrals, patient accounts issues and/or questions related to billing and insurance needs will be worked/addressed in a timely manner. Prepares documents to fax or mail out to insurance payers to complete and obtain the pre-certifications/authorizations. Documents communication in the EHR and updates referral statuses. Acts as a representative to complete referrals and financial information which serves the patient/customer population within UNC Health Wayne scheduled appointments and admissions.
Responsibilities:
1. Performs coverage discovery efforts to verify coverage.
2. Runs RTE to verify all insurance payers electronically; call insurance companies as needed.
3. Initiates the authorization/precertification process for referrals in Epic.
4. Update the referral status and auth/cert status in EPIC.
5. Acknowledge and responds to requests for authorizations and retro authorizations.
6. Escalate matters/scheduled accounts that require attention to Pre-Arrival Team Lead/Manager.
7. Notify Utilization Review & Case Management regarding any admissions that need Clinical Review.
8. Review/Sign/Commit to the Patient Access Work Standards approved by Human Resources
9. Review the Patient Access Weekly Huddle Minutes to ensure updates/changes are communicated for work processes, EPIC changes, Department Meetings, Training Classes, ETC.
10. Abides by the UNC Health Wayne – Referral Management & Financial Clearance Collections Policies.
11. Uses professional customer service in all patient and teammate interactions.
Other information:
Education
High School graduate or equivalent required.
Licensure/Certification
None required.
Experience
Prior experience with Preauthorization’s/Customer Service, dealing with the public and/ or healthcare organization is strongly preferred. Computer literate. Office equipment use and knowledge such as fax machines,10 key calculators, printers, copiers, etc.
Knowledge, Skills and Abilities
• Demonstrated analytical, customer service, and interpersonal skills.
• Strong organizational skills & good attention to details.
• Must have knowledge of Medicare/Medicaid and Commercial Insurance payers.
• Ability to prioritize and multi-task.
• Ability to read, write and communicate effectively in English.
• Proficient with MS Office and Epic with the ability to to learn new software rapidly. Previous Electronic Health Record EPIC preferred experience.
• Able to work with deadlines and within timelines.
• Telephone etiquette.
• Must have effective oral and written English communication skills to communicate in a clear and concise manner with patients, physicians, public, teammates and administration.
• Will always portray a professional public image.
• Ability to complete authorizations/precertification’s within deadlines.
• Ability to Follow-up with patient accounts to obtain retro authorizations.
Valid NC Driver’s License: No
If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.
Job Details
Legal Employer: Wayne Health
Entity: Wayne UNC Health Care
Organization Unit: Admitting
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: WAYNE MED
Exempt From Overtime: Exempt: No