[Hiring] Payer Notification III @Wellstar Health System

Role Description

The Patient Access Services (PAS) Prior Authorization Specialist III position reports to the PAS Manager of Pre-Service Operations and is responsible for securing accounts by performing a combination of insurance verification to gather benefit information and validating prior authorization with the payer before services are rendered.

• Weekend Shift: Saturday & Sunday

This position works with physicians, nurses, clinic managers, and financial advocates to resolve issues during the prior authorizations process. It may also support Pre-Registration, including preparing patient estimates, while maintaining established productivity benchmarks in a fast-paced environment.

• Quality/Safety Responsibilities:
• Works with Insurance Verification Specialist to verify insurance eligibility, benefits, and network status.
• Ensures accurate ICD, CPT codes, and related medical records are submitted in the authorization request.
• Secures prior authorizations for scheduled and nonscheduled services.
• Acts as a liaison between the payer and clinic schedulers/medical support staff.
• Follows up on delayed or denied authorization requests and escalates for resolution.
• Creates detailed documentation and maintains the authorization paper/electronic trail.
• May work in the work queues to resolve claims denials related to the prior authorization.
• Observes work hours and provides proper notice of absences, tardiness, or work schedule changes.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, and the public.
• Presents a well-groomed and professional image.
• Documents thorough explanatory notes on patient accounts concerning any non-routine circumstances.
• Maintains a working knowledge of available information system capabilities.
• Understands and applies WHS philosophy and objectives, and PAS policies and procedures.
• Maintains confidentiality of patient information in accordance with WHS policy and HIPAA regulations.
• Demonstrates the ability to organize work and complete tasks productively.
• Maintains proficiency in data entry skills.
• Assists physicians and their office staff to expedite scheduling and pre-certifications.
• Resolves errors and applicable Claim, DNB, and Patient Work Queues.
• Budget/Financial Responsibilities:
• Attempts to collect the estimated self-pay balance of all accounts at the earliest possible collection control point.
• Monitors in-house accounts and attempts to make financial arrangements with guarantors.
• Completes financial evaluation forms to document guarantors' financial status.
• Identifies patients without adequate insurance coverage and contacts them for financial assistance.
• Maintains a list of healthcare financial assistance programs and refers patients as needed.
• Works efficiently within designated time frames to ensure continuity of information and cash flow.
• Contacts scheduled patients to obtain pre-admission information and explain financial policies.
• Interviews all inpatients and select outpatients at registration to verify insurance and financial information.
• Documents concise notes regarding all self-pay account collection activity.
• Coordinates financial counseling activities with various departments.
• Verifies insurance coverage and benefits.
• Exceeds monthly quota on a consistent basis and reports results to the supervisor.
• Responsible for completion of appropriate errors/issues in WorkQueues.
• Identifies and resolves Payor Denials as indicated.
• Customer Service Responsibilities:
• Greets all guests with a positive and professional attitude.
• Receives patients' valuables for safekeeping in the hospital safe.
• Answers incoming phone calls and follows through with requests.
• Maintains courteous and cooperative working relationships with WHS management and the public.
• Presents a well-groomed and professional image in coordination with department dress codes.
• General Responsibilities:
• Observes work hours and provides proper notice of absences or schedule changes.
• Attends select departmental meetings at the request of WHS Management.
• Completes mandatory training as required.
• Serves as preceptors and mentors for new patient access personnel and students.
• Maintains required certifications by obtaining necessary CEUs.

Qualifications

• High School Diploma or GED required; Associates degree preferred.
• Minimum 1 year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services required.
• Bachelor's degree or higher may substitute for experience.
• Epic experience preferred.

Requirements

• Effective communication skills (both written and verbal).
• High attention to detail, self-directed, and a positive attitude.
• Effective problem-solving and critical thinking skills.
• Typing or data entry competency of at least 40 words/minute.
• Cash handling and balancing experience.
• Demonstrated professionalism and active listening skills.
• Working knowledge of patient registration systems and intermediate Microsoft Office Suite preferred.

Benefits

• Support to do more meaningful work.
• Enjoy a more rewarding life.
• Connect with the most integrated health system in Georgia.