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UNC Health · 20 hours ago

Pre-Arrival Specialist - Johnston Scheduling

Smithfield, NC

Full-time

Hybrid

Entry Level

$18.84/hr - $26.77/hr

2+ years exp

UNC Health is an inclusive organization with over 40,000 teammates dedicated to improving community health and well-being. The Pre-Arrival Specialist is responsible for obtaining necessary pre-authorizations from payors and ensuring referrals are linked to accounts, while also maintaining accurate documentation and following up on denials.

Addiction TreatmentHealth CareHealth DiagnosticsHospitalNon ProfitWellness

Responsibilities

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

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

Accurately document all pre-authorizations/prior-approvals according to healthcare system standards

Coordinate peer to peer or medical review cases with the provider or clinic Patient Financial counselor as needed

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

Ensures ADT information is current and accurate to ensure patient safety, charging, coding, insurance processing, and billing accuracy

Qualification

Healthcare experienceInsurance authorizationMedical terminologyCustomer serviceBasic computer skillsAnalytical skillsMathematical skillsReasoning abilityOrganizational skills

Required

High school diploma or general education degree (GED) required

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

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

Ability to comprehend advanced mathematical principles and advanced statistical theory

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