Pre-Arrival Authorization Specialist

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.

• Performs coverage discovery efforts to verify coverage.
• Runs RTE to verify all insurance payers electronically; call insurance companies as needed.
• Initiates the authorization/precertification process for referrals in Epic.
• Update the referral status and auth/cert status in EPIC.
• Acknowledge and responds to requests for authorizations and retro authorizations.
• Escalate matters/scheduled accounts that require attention to Pre-Arrival Team Lead/Manager.
• Notify Utilization Review & Case Management regarding any admissions that need Clinical Review.
• Review/Sign/Commit to the Patient Access Work Standards approved by Human Resources.
• Review the Patient Access Weekly Huddle Minutes to ensure updates/changes are communicated for work processes, EPIC changes, Department Meetings, Training Classes, ETC.
• Abides by the UNC Health Wayne – Referral Management & Financial Clearance Collections Policies.

Uses professional customer service in all patient and teammate interactions.

High School Diploma or equivalent required, any higher education from an accredited college will supersede this requirement.

None required.

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.

• 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 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:
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.