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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

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 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

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.