Team Lead PAS Pre-Service Operations WMCG

Team Lead PAS Pre‑Service Operations WMCG

4 days ago
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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)

The Pre‑Service Operations (PSO) Team Lead Pre Registration and/or Insurance Verification is responsible for ensuring all eligible accounts are verified and preregistered within the designated time frames and are documented appropriately in the patient accounting system. The PSO Team Lead will track and trend recovery efforts, report ongoing problems specific to payers, health system departments and/or contracts, collaborate with the Manager and Director, assist the team with daily workflow, and represent the Manager in meetings as needed.

• Collect authorizations for procedures by contacting assigned payers.
• Execute the authorization process to ensure that an authorization issues do not cause payer denials, including receiving, assessing, documenting, tracking, responding to, and authorizing 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 departmental tools.
• Appropriately report ongoing 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 departmental policy, including using correct grammar and spelling, and monitor staff for appropriate appeals.
• Identify contract issues related to unpaid claims and communicate those issues to the 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 productivity standards in addressing and resolving denied accounts, including monitoring denial write‑off adjustments and timely escalation.
• Consistently meet quality standards by 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.
• Contribute to the overall department AR goal.
• Identify opportunities for system and process improvement and submit to management.
• Demonstrate proficiency with systems and execution of processes in all areas of responsibility.
• Maintain knowledge of HIPAA privacy standards and ensure compliance with PHI privacy practices.
• Follow general Policy and Procedures, departmental Policy and Procedures, and Emergency Preparedness Procedures.
• Cross‑train and fill in for other staff as assigned; train and mentor team members.
• Assist Manager in daily assignment for team workflow, special assignments, meetings, and morale.
• Understand all reports and metrics used for AR management.
• Assure patient privacy and confidentiality as appropriate or required.
• Communicate professionally with patients, families, payor representatives, physicians, co‑workers, management and clinical staff.
• Maintain professional relationships and convey relevant information to other members of the healthcare team and referral agencies.
• Initiate communication with peers about changes and procedures; relay information appropriately over telephone, email and other devices.
• Interact with internal customers including HIM, Revenue Integrity, Patient Access and the SBO to achieve revenue…