Pre Authorization Lead - Chicago, United States - Rush University

Rush University

Verified Company

Chicago, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

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 preappointment 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 coordination 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 problemsolving 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 multitasking 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
24 Years' experience in Patient Access or obtaining preauthorizations
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.

Collects and analyzes demographic, insurance and other information from patients, guarantors and all other sources to accurately obtain authorization for scheduled procedure.
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
Assists management with daily operational duties, reports and conducting daily huddles.
Analyze department dash boards and daily/weekly reports.
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.
Initiate service recovery for patient complaints when required and escalate to supervisor as needed.
Acts as a first point of contact for Admissions Registration Specialists to facilitate and develop solutions to problems and escalate to supervisor as needed.
Acts as a champion of new initiatives to support management to implement new processes and workflows.
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.
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
Performs registr