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Pre-Arrival Specialist

This job posting is no longer active.

Job ID: 10703
Location: Raleigh, NC
Facility/Division: UNC REX Healthcare
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
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.


Responsibilities:
1. 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.
2. 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.
3. Accurately document all pre-authorizations/prior-approvals according to healthcare system standards.
4. Coordinate peer to peer or medical review cases with the provider or clinic Patient Financial counselor as needed.
5. 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.
6. Ensures ADT information is current and accurate to ensure patient safety, charging, coding, insurance processing, and billing accuracy.


Other Information

Other information:
Education Requirements:
● High school diploma or general education degree (GED) required. Associated degree preferred.
Licensure/Certification Requirements:
Professional Experience Requirements:
● 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. Medical terminology desired.
Knowledge/Skills/and Abilities Requirements:
● Language 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. Mathematical Skills: Ability to comprehend advanced mathematical principles and advanced statistical theory. Reasoning Ability: 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.


Job Details

Legal Employer: NCHEALTH

Entity: UNC REX Healthcare

Organization Unit: Cancer Center Revenue Oncology 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Raleigh

Exempt From Overtime: Exempt: No



This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

Equal Employment Opportunity

UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.

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