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 peers about changes and procedures * Relay information appropriately over telephone, email, and other communication devices * Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives. * Department Methods/Procedures/Operations * Follow and assist Manager with guidelines for lunch, breaks, requesting time off, and shift assignments for staff. * Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies. * Follow JCAHO and outside regulatory agencies mandated rules and procedures. * Perform other duties and responsibilities as assigned * Monitors patient throughput and adjusts staffing and processes as appropriate to ensure the most efficient patient throughput. * Participates in customer service teams. * Resolves patient, physician, interdepartmental and other customer issues in a timely and appropriate manner. * Demonstrates ability to tactfully handle difficult situations through an approach that reflects consistency. * Monitors facility and area customer service scores and works with management team on action plan. * Maintains positive relationships with other department personnel. * Pursues excellence in all areas related to customer service, including service recovery. * Expected Performance, Behaviors and Results: * The WellStar Experience (Must demonstrate a commitment to Service Excellence by): * Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members. * Valuing patients and family members as partners in their care. * Having world-class processes in place. * Delivering high-touch care that is reliable, responsive and coordinated. * Focusing on constant innovation and creating improvements. * Celebrating our diversity with sensitivity and understanding. * Embracing the idea that we are all owners of our health system. Quality/ Safety * Implementation and training of new programs/updates to employees. * Responsible for quality and performance monitoring and reporting. Compiles and distributes data from management reports in a timely and accurate manner. Works with Supervisor to analyze data to make changes as appropriate. * Takes initiative to appropriately investigate and resolve department issues as they arise. * Understands and enforces policies and procedures for assigned areas. * Assists with investigating account issues, such as denials, tracking and trending problems, and implementing changes and education as appropriate. * Assists with meeting all quality goals (i.e. patient throughput). * Monitors, ensures maintenance and resolves of accounts, DNB/Denials, claim, patient, and other related Work queues that impact the Revenue Cycle. * Participates in monthly Denial resolution for respective facility. * Ensures quality and drives resolution of initiatives which impact the overall health of the Revenue Cycle.

Required Minimum Education:

• High School Diploma General or GED General or Associates Other-Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• CHAA - Cert Healthcare Access Assoc or CPAR - Certified Patient Account Rep or CRCR - Certified Revenue Cycle Rep or CRCR-P - Certified Revenue Cycle Rep - Provisional (90 Days) within 120 Days

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 1 year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services. Required and Bachelors degree or higher may substitute for experience. Required and Epic experience Preferred

Required Minimum Skills:

Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team. High attention to detail, self-directed and a positive attitude are essential. Effective problem solving and critical thinking skills. Typing or data entry competency of at least 40 words/minute. Cash handling and balancing. Demonstrated professionalism, effective communication skills and active listening skills.

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