Pre Authorization Lead - Rush University Medical Center
Chicago, IL
About the Job
Job Description
Location: Chicago, IL
Hospital: RUSH University Medical Center
Department: Patient Access (Pre-Visit)
Work Type: Full Time (Total FTE between 0.9 and 1.0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)
Summary:
The Pre- Authorization Specialist Lead is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, the Pre- Authorization Specialist II may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim. The Pre- Authorization Specialist Lead is proficient in working in a multitude of WQs outside their assigned ones. Responsible for orientation of any new staff. The Pre-Authorization Specialist Lead is responsible for assisting management with the daily operational duties and reports. Execution of these activities must be in compliance with insurance requirements and in co-ordination with the patient, ordering physician and service area. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Other information:
• High school graduate or equivalent
• 2+ years of experience
• Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service
• Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel)
• Excellent communication and outstanding customer service and listing skills.
• Basic keyboarding skills
• Ability to analyze and interpret data
• Critical thinking, sound judgment and strong problem-solving skills essential
• Team oriented, open minded, flexible, and willing to learn
• Strong attention to detail and accuracy required
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral and written instructions and established procedures
• Ability to function independently and manage own time and work tasks
• Ability to maintain accuracy and consistency
• Ability to maintain confidentiality
Preferred Job Qualifications:
• Associates Degree in Accounting or Business Administration
• 2-4 Years’ experience in Patient Access or obtaining pre-authorizations
• Knowledge of insurance and governmental programs, regulations, and billing processes e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.
• Working knowledge of medical terminology and anatomy and physiology is preferable.
Responsibilities:
Collects and properly records demographic and insurance information required to properly address the customers' financial issues. Verifies patient’s eligibility from resources provided by third party payers and portals and other on lines services.
2. Collects and analyzes demographic, insurance and other information from patients, guarantors and all other sources to accurately obtain authorization for scheduled procedure.
3. Oversees the department’s preceptors for new hire Orientation by assisting the supervisors in monitoring the new hire’s ability to perform the SOW of their job. Acts as a resource to new and current staff by answering questions, assistance of daily job functions and corrections of errors
4. Assists management with daily operational duties, reports and conducting daily huddles.
5. Analyze department dash boards and daily/weekly reports.
6. Identify problem areas with prioritizing daily work, be able to escalate concern to supervisors, to ensure that all areas accounts are completed by end of day.
7. Initiate service recovery for patient complaints when required and escalate to supervisor as needed.
8. Acts as a first point of contact for Admissions Registration Specialists to facilitate and develop solutions to problems and escalate to supervisor as needed.
9. Owns relationships with team members, attends regular meetings, communicates back to team, and serves as a subject matter expert in your Revenue Cycle area’s specific knowledge.
10. Acts as a champion of new initiatives to support management to implement new processes and workflows.
11. Assemble information concerning the patient’s clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.
12. Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and clinical notes. Provide specific medical information to financial services to maximize reimbursement to the hospital and professional service providers
13. Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy and security Regulations, as well as JACHO.
14. Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital payment policy. Offers option of Financial Counselors to assist with arriving at acceptable resolution of estimated patient balance.
15. Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities. Ability to exercise exceptional customer service skills when communicating with both our patients as well as our internal customers. Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
16. Performs other duties as assigned for the operational effectiveness and success of the department.
17. Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
18. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Rush University Medical Center’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected
19. Attends regular EPIC training sessions or other sessions conducted for the benefit of associates involved in the Financial Counseling functions.
20. Other duties as needed and assigned by the supervisor/manager
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position Pre Authorization Lead
Location US:IL:Chicago
Req ID 6126
Location: Chicago, IL
Hospital: RUSH University Medical Center
Department: Patient Access (Pre-Visit)
Work Type: Full Time (Total FTE between 0.9 and 1.0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)
Summary:
The Pre- Authorization Specialist Lead is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, the Pre- Authorization Specialist II may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim. The Pre- Authorization Specialist Lead is proficient in working in a multitude of WQs outside their assigned ones. Responsible for orientation of any new staff. The Pre-Authorization Specialist Lead is responsible for assisting management with the daily operational duties and reports. Execution of these activities must be in compliance with insurance requirements and in co-ordination with the patient, ordering physician and service area. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Other information:
• High school graduate or equivalent
• 2+ years of experience
• Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service
• Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel)
• Excellent communication and outstanding customer service and listing skills.
• Basic keyboarding skills
• Ability to analyze and interpret data
• Critical thinking, sound judgment and strong problem-solving skills essential
• Team oriented, open minded, flexible, and willing to learn
• Strong attention to detail and accuracy required
• Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
• Ability to follow oral and written instructions and established procedures
• Ability to function independently and manage own time and work tasks
• Ability to maintain accuracy and consistency
• Ability to maintain confidentiality
Preferred Job Qualifications:
• Associates Degree in Accounting or Business Administration
• 2-4 Years’ experience in Patient Access or obtaining pre-authorizations
• Knowledge of insurance and governmental programs, regulations, and billing processes e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.
• Working knowledge of medical terminology and anatomy and physiology is preferable.
Responsibilities:
Collects and properly records demographic and insurance information required to properly address the customers' financial issues. Verifies patient’s eligibility from resources provided by third party payers and portals and other on lines services.
2. Collects and analyzes demographic, insurance and other information from patients, guarantors and all other sources to accurately obtain authorization for scheduled procedure.
3. Oversees the department’s preceptors for new hire Orientation by assisting the supervisors in monitoring the new hire’s ability to perform the SOW of their job. Acts as a resource to new and current staff by answering questions, assistance of daily job functions and corrections of errors
4. Assists management with daily operational duties, reports and conducting daily huddles.
5. Analyze department dash boards and daily/weekly reports.
6. Identify problem areas with prioritizing daily work, be able to escalate concern to supervisors, to ensure that all areas accounts are completed by end of day.
7. Initiate service recovery for patient complaints when required and escalate to supervisor as needed.
8. Acts as a first point of contact for Admissions Registration Specialists to facilitate and develop solutions to problems and escalate to supervisor as needed.
9. Owns relationships with team members, attends regular meetings, communicates back to team, and serves as a subject matter expert in your Revenue Cycle area’s specific knowledge.
10. Acts as a champion of new initiatives to support management to implement new processes and workflows.
11. Assemble information concerning the patient’s clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.
12. Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and clinical notes. Provide specific medical information to financial services to maximize reimbursement to the hospital and professional service providers
13. Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy and security Regulations, as well as JACHO.
14. Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital payment policy. Offers option of Financial Counselors to assist with arriving at acceptable resolution of estimated patient balance.
15. Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities. Ability to exercise exceptional customer service skills when communicating with both our patients as well as our internal customers. Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
16. Performs other duties as assigned for the operational effectiveness and success of the department.
17. Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
18. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Rush University Medical Center’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected
19. Attends regular EPIC training sessions or other sessions conducted for the benefit of associates involved in the Financial Counseling functions.
20. Other duties as needed and assigned by the supervisor/manager
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Position Pre Authorization Lead
Location US:IL:Chicago
Req ID 6126
Source : Rush University Medical Center