Team Leader, Prior-authorizations - Oceanport, United States - RWJBarnabas Health

RWJBarnabas Health

Verified Company

Oceanport, United States

4 days ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Summary:

The Team Leader acts as a trainer, resource, and mentor for less experienced staff, and assists team supervisors with communication, education, and risk escalation as needed.

The Team Leader demonstrates strong performance and understanding of EMR system workflows, supports proactive risk identification and communication to supervisors, and successfully adopts and educates team members on new processes, policies, workflows, and system upgrades.

The Team Leader has strong knowledge and experience with pre-authorizations.

Essential Functions:

Executes accurate and timely completion of patient insurance verification, benefit package review (including patient liability, in/out of network coverage, and subsequent insurance coverage), patient liability documentation, and next steps/actions in account notes.
Updates patient account with coverage, guarantor, benefit, and demographic information accurately and consistently in EMR system. Resolves any issues with coverage and escalates complicated issues to manager.
Contacts patients to confirm outstanding demographic, guarantor, or coverage information in order to secure all required data on patient accounts (if needed).
Exhibits excellent customer service, courteous phone manner, and knowledgeable rapport when managing communication to/from patients (if needed).
Reviews patient procedural information in order to obtain and/or verify timely completion of preauthorization codes documented on patient accounts.
Utilizes available tools to expedite and automate critical functions of patient account work, including but not limited to: Real Time Eligibility (RTE) eligibility software, payor websites, third party verification websites, payor phone lines, and autoauthorization tools.
Maintains and/or owns account volumes within EMR work queues; demonstrates organization and priority awareness when completing or deferring account work.
Manages appropriate communication (including account escalations) to and from outside departments including but not limited to: RWJBH clinics, scheduling departments, and referring departments.
Sustains consistent levels of account productivity and quality based on department and role needs; escalates quality or productivity barriers to supervisor(s) in time manner.
Maintains full compliance with all organizational policies, procedures, and compliance regulations regarding operational processes, patient information privacy, and technical security.
Participates in and completes all required employee trainings, including recurring and adhoc education sessions.
Assist leadership in conducting followup on identified discrepancy and root cause analysis to prevent systematic recurrence of financial clearance, documentation, and quality issues.
Assists with training, auditing of work, and provides feedback to Team Supervisors on opportunities for improvement. Supports leadership in ensuring productivity goals, metric benchmarks, and quality standards are consistently met by all team members.
Helps resolve more complex and/or escalated patient eligibility, benefit coverage, liability payment, and authorization inquiries and problems, handling followup questions from patients, and resolving user discrepancies or errors.
Acts as a liaison to Team Supervisor to obtain necessary information and resolve process discrepancies or inefficiencies.

Job Requirements:

Education
H.S. Diploma or Equivalent (required)
Experience 1 year administrative and/or supervisor experience in a health care environment. (required)
Knowledge of thirdparty eligibility and clinical preauthorization regulations and payer requirements. (required)
Must be detail oriented and have strong organization and communication skills.
Possess a strong work ethic and a high level of professionalism.
Demonstrate effective customer service and communication skills.
Must be a dependable selfstarter and deadline driven. Must have ability to work well independently and in a team setting to meet organizational goals.
Must demonstrate solid understanding of key revenue cycle workflows, technical system, and metric goals. Must hold self to high quality standards in all areas of Team Lead role to lead by example for less experienced team members.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.

Duties, responsibilities and activities may change at any time with or without notice.

Additional Information:

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.