Team Lead PAS Pre-Service Operations WMCG

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Various (United States of America)

Job Summary:

The Pre-Service Operations (PSO) Team Lead PreRegistration and/or Insurance Verification is responsible for ensuring all eligible accounts are verified and preregistered within the designated timeframes and are documented appropriately in the patient accounting system. Additionally, the PSO Team Lead will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The PSO Team Lead will work collaboratively with their Manager and Director to ensure necessary communication and feedback to the departments takes place in a timely manner. The PSO Team Lead is also responsible for assisting the team in daily workflow, questions and general team assignments. The PSO Team Lead should be aware of all team payer issues and current action plans for decreasing coverage denials. The PSO Team Lead at times may need to assist or represent their Manager in meetings.

Core Responsibilities and Essential Functions:

Duties and Responsibilities * Collect authorizations for procedures by contacting assigned payers * Execute the authorization process to ensure that an authorization issues do not cause payer denials, which includes receiving, assessing, documenting, tracking, responding to, and authorizations in a timely manner. * Work with clinical staff as needed to follow-up. * Prepare, maintain, assist with, and submit reports as required. * Track and trend recovery efforts by utilizing various departmental tools. * Appropriately report on-going problems specific to health system departments, and/or contracts. * Provide feedback and process improvement ideas to management regarding facility, Patient Access, * Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for appeal * Correct denied claims with authorization in accordance with methodology in departmental policy and procedure including using correct grammar and spelling, monitor staff for appropriate appeals. * Identify contract issues related to unpaid claims and communicate those issues to Director. * Transmit required documentation to Government and third-party payers for the purpose of resolving payments. * Ensure all payer contact is fully documented in the appropriate software application. * Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to the unit supervisor. * Consistently meet the current productivity standards in addressing and resolving denied accounts including monitoring appropriate denial write off adjustments from staff and timely escalation. * Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues. * Manage productivity standards, targets, error ratios and reporting requirements of assigned team members. Management * Provide individual contribution to the overall team effort of achieving the department AR goal. * Identify opportunities for system and process improvement and submit to management. * Demonstrate proficient use of systems and execution of processes in all areas of responsibilities. * Demonstrate knowledge of the health system HIPAA privacy standards and ensure compliance with system PHI privacy practices. * Follow the health systems general Policy and Procedures, the Departments Policy and Procedures, and the Emergency Preparedness Procedures * Become cross-trained and fill in for other staff as assigned, train and mentor team members. * Assist Manager in daily assignment for Team workflow, team special assignments, Team meetings Team morale. * Have a clear working understanding of all report and metrics used for AR management. Administrative, Professional Communication, Customer Service * Assure patient privacy and confidentiality as appropriate or required. * Communicate in a professional manner with patients, their families, and representatives from third party payor organizations including physicians, physician staff, co-workers, management and clinical staff. * Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies. * Initiate communication with p