Scheduled Hours

40

Position Summary

The Pre-Arrival Team Lead coordinates daily assignments to ensure the team’s ability to complete high volumes in a timely manner. Responsible for team’s accuracy of registration and insurance plan/FSC information of patient accounts. Additionally, the Pre-Arrival Lead coordinates the workload and processes for obtaining procedure authorizations and referrals. Acts as a resource to staff in their team and others. This position requires heavy call volume to insurance companies, third party administrators, physician offices, and employers to verify eligibility, obtain referrals and authorizations, and to obtain specific benefit information pertaining to oncology visits.

Job Description

Primary Duties & Responsibilities:

• Lead your assigned teams - Eligibility, Benefits or Referral, in daily activities and the prioritization of tasks. Assist in adjusting assignments based on coverage needs of the entire unit.
• Work daily assignments in the Eligibility, Benefits and Referrals, such as, work eligibility and/or referral pre-arrival alerts in Alerts Manager.
• Coordinate, obtain and accurately document and communicate referrals and authorizations.
• Accurately convert Generic Plans into P plans on daily basis.
• Accurately assign a FSC/Plan or ascertain integrity of existing plan/FSC.
• Contact Payer/ TPA by phone regarding eligibility.
• Contact Payer/TPA by phone to complete a worksheet for benefits pertaining to Oncology visits/treatments.
• Contact patients when necessary to discuss self-pay status, non-contracted plans and financial options. Refer patients to financial counselors.
• Access BJH system and various web sites for insurance/eligibility information.
• Identify registration issues related to visits and invoices.
• Support clinical areas for questions regarding registration, benefit and referrals. Send financial alerts and notifications to inform Divisions of potential financial liability.
• Manage TES and ETM files as assigned by manager. Update invoices and redirect claims to appropriate payers when appropriate.
• Send financial alerts/notification to Divisions to advise of potential financial liability.
• Provide education and training to staff.
• Provide feedback to management regarding staffing concerns and process improvement. Other duties as assigned by manager.

Working Conditions:
Job Location/Working Conditions

• Normal office environment.

Physical Effort

• Typically sitting at desk or table.
• Occasional lifting (25 lbs or less).

Equipment

• Office equipment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education:

High school diploma or equivalent high school certification or combination of education and/or experience.

Certifications:

No specific certification is required for this position.

Work Experience:

Medical Billing/Coding (3 Years)

Skills:

Not Applicable

Driver's License:

A driver's license is not required for this position.

More About This Job

Required Qualifications:

• Previous pre-certification experience.

Preferred Qualifications:

• Some college or associate degree.
• Coding experience preferred.
• Applicant must have a thorough understanding of both Washington University FSC database and insurance terminology.
• Experience interacting with managed care plans, insurance companies and third-party payers.
• Ability to work with internal and external customers, including physicians, nurses, patients and families.

Preferred Qualifications

Education:

Associate degree

Certifications:

Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experie