Pre-Arrival Specialist

2 days ago

Smithfield, United States UNC Health Full time

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Hours of operation is 8am to 5pm

Summary:
Obtains approval from all payors requiring pre-authorization/prior-approval, prior to or on the date of service. Ensures referrals are created and linked to all applicable accounts.

Responsibilities:
1. Obtains approval from all payors requiring pre-authorization/prior-approval, prior to or on the date of service. Ensures referrals are created and linked to all applicable accounts. Obtains required clinical and financial information required for authorization when applicable.
2. Review accounts for medical necessity according to NCCN, FDA, Medicare LCD/NCD coverage determinations, and payor guidelines prior to or on the date of service. Discuss accounts with revenue cycle coordinator or manager that fall outside of medical necessity parameters.
3. Accurately document all pre-authorizations/prior-approvals according to healthcare system standards.
4. Coordinate peer to peer or medical review cases with the provider or clinic Patient Financial counselor as needed.
5. Complete timely denial follow up for infusion and radiation therapy authorization and medical necessity denials. Complete accurate and timely documentation, follow-up, and appeals per payor guidelines. Follow denied accounts to resolution. Maintain work queues per established productivity standards.
6. Ensures ADT information is current and accurate to ensure patient safety, charging, coding, insurance processing, and billing accuracy.

Other Information

Other information:
Education Requirements:
• High school diploma or general education degree (GED) required. Associated degree preferred.
Licensure/Certification Requirements:
Professional Experience Requirements:
• Two years of experience in healthcare setting with exposure to patient registration, billing, denial management, or insurance authorization processes required. Requires exceptional customer service, organizational, and basic computer skills. Medical terminology desired.
Knowledge/Skills/and Abilities Requirements:
• Language Skills: Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints. Ability to write speeches and articles using original or innovative techniques or style. Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors. Mathematical Skills: Ability to comprehend advanced mathematical principles and advanced statistical theory. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.,) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables.

Job Details

Legal Employer: NCHEALTH

Entity: Johnston Health

Organization Unit: Scheduling

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $18.20 - $25.86 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Smithfield

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

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.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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