Job Description
Description
Summary:
The Pre- Arrival Authorization Specialist I will serve patients/customers and physician offices by obtaining authorizations from insurance payers prior to services being 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 Diploma or equivalent required, any higher education from an accredited college will supersede this requirement.
Licensure/Certification
None required.
Experience
Prior experience with Preauthorizations/Customer Service, dealing with the public and/or healthcare organization strongly preferred.
Prior experience working with computer workstations as well as regular office equipment.
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: Centralized Registration
Work Type: Part Time
Standard Hours Per Week: 24.00
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: WAYNE MED
Exempt From Overtime: Exempt: No
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
Description
Summary:
The Pre- Arrival Authorization Specialist I will serve patients/customers and physician offices by obtaining authorizations from insurance payers prior to services being 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 Diploma or equivalent required, any higher education from an accredited college will supersede this requirement.
Licensure/Certification
None required.
Experience
Prior experience with Preauthorizations/Customer Service, dealing with the public and/or healthcare organization strongly preferred.
Prior experience working with computer workstations as well as regular office equipment.
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: Centralized Registration
Work Type: Part Time
Standard Hours Per Week: 24.00
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: WAYNE MED
Exempt From Overtime: Exempt: No
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
About UNC Health
Our mission is to improve the health and well-being of North Carolinians and others whom we serve. We accomplish this by providing leadership and excellence in the interrelated areas of patient care, education and research.
UNC Health and its 33,000 employees, continue to serve as North Carolina’s Health Care System, caring for patients from all 100 counties and beyond our borders. We continue to leverage the world class research conducted in the UNC School of Medicine, translating that innovation to life-saving and life-changing therapies, procedures, and techniques for the patients who rely on us.
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