Team Leader, Prior-AuthorizationsReq #:0000151087

Category:Billing/Collections/Registration

Status:Full-Time

Shift:Day

Facility:RWJBarnabas Health Corporate Services

Department:Centralized Scheduling

Location:

System Business Office, 2 Crescent Place, Oceanport, NJ 07757

Job Summary:

Under general supervision, the Centralized Access Team Leader is responsible for consistently and accurately verifying patient insurance, reviewing patient benefit packages, confirming and/or obtaining pre-authorizations, and documenting due diligence of visit account completion prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. The Team Leader may be responsible for contacting patients via phone to complete Electronic Medical Record (EMR) system records, interpret coverage limitations, evaluate patient versus insurance coverage, attempt patient liability collections, follow up with payors/patients to secure accounts and respond to insurance verification questions. The Team Leader performs accurate documentation and account work within Epic system work queues and maintains regular productivity in alignment with department expectations. The Team Leader may also be responsible for outside communication to and from the Centralized Access department in order to complete patient account work, including but not limited to: clinic departments, RWJBH Revenue Cycle Team, ITS, RWJBH Training Team, Operations leadership, payor representatives, and non-RWJBH referring providers. The Team Lead possesses reasonable knowledge of and competency in healthcare EMR systems, manual data entry, email communication, and the patient account lifecycle.

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 pre-authorization 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 auto-authorization 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 ad-hoc education sessions.

• Assist leadership in conducting follow-up on identified discrepancy and root cause analysis to prevent systematic recurrence of financial clearance, documentation, and quality issues.

• Serves as an operational and technical subject-matter expert, providing direction to less experienced staff.

• 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 follow-up 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 third-party eligibility and clinical pre-authorization regulations and payer requirements. (Required)

• Must be detail oriented and have strong organization and communication skills.

• Proficient computer skills including ability to learn EMR system workflows, automated software tools, manage email inbox, and utilize Microsoft Office Suite, as needed.

• Possess a strong work ethic and a high level of professionalism.

• Demonstrate effective customer service and communication skills.

• Must be a dependable self-starter 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.

• Paid Time Off (PTO)

• Medical and Prescription Drug Insurance

• Dental and Vision Insurance

• Retirement Plans

• Short & Long Term Disability

• Life & Accidental Death Insurance

• Tuition Reimbursement

• Health Care/Dependent Care Flexible Spending Accounts

• Wellness Programs

• Voluntary Benefits (e.g., Pet Insurance)

• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employe

RWJBarnabas Health is an Equal Opportunity Employer