Pre-Arrival Authorization Specialist I

**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. 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.