Pre-Arrival Authorization Specialist I

Description

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

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.

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