Sr. CRD and Preauthorization Specialist

Job Code: SRPRE- 112
Revision Date: January 13, 2025

Starting Salary: $19.52 hourly; $40,606 annually

FLSA: Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

The purpose of this position is to provide support to staff regarding financial registration and preauthorization processes. This position must possess leadership skills, critical thinking skills and knowledge in financial requirements both state and Charity Care, verification of benefits, and eligibility inquiries, as well as an understanding of how these areas impact the flow of work throughout the departments and organization. Lead will maintain and enforce policies and/or procedures as necessary related to the core tasks of the Revenue Cycle Department.

This class works under general supervision, independent working methods and sequences. Will report directly to the CRD and Preauthorization Supervisor.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

• Assist with staff scheduling, directing assigned staff, processing employee concerns and problems, directing workload, counseling regarding preauthorization and financial assessment process.
• Coordinates and/or provides training for both internal and external staff, ensures cross training occurs, and other related staff development activities as needed.
• Understand and stay informed of the latest billing guidelines for Medicare, Medicaid, MCO's, commercial insurances, and self-pay.
• Monitors individual and team progress toward meeting daily and monthly goals while giving specific/timely feedback.
• Works collaboratively with Financial and Preauthorization Supervisor to develop individual and/or team development plans to achieve competence with all goals and priorities.
• Ensure that department functions are carried out according to policies, procedures, and expectations.
• Provide feedback on daily registration processes and staffing issues to the supervisor.
• Serve as a knowledge expert and an escalation point for staff questions and concerns regarding preauthorization and financial assessment process.
• Adhere to productivity standards using key performance indicators (KPIs) and established healthcare billing metrics.
• Facilitates staff and team problem solving sessions by using structured problem-solving methods and tools.
• Uses monitoring and tracking tools and techniques to evaluate barriers, alternatives, and resolutions.
• Assist supervisor with large projects/assignments into phases with projected due dates and resource requirements.
• Consistently shows ability to recognize and deal with priorities depending on urgency and routine status.
• Assist team members in gathering all relevant information required to process financial assistance requests.
• Assist team members in documenting accurately all communication and follow up in the EHR.
• Accurately reviews all necessary financial assessment information including appropriate documentation to support financial review, required signatures (patient and staff), and insurance and billing information if applicable (related to determine ability to pay).
• Registers all patients under special funding in accordance with contract requirements.
• Develop and maintain communication with assigned clinic supervisors/managers in matters regarding patient account or financial/charity care assessment.
• Public Health Provider-Charity Care Program (PHP-CCP)-
• Responsible for learning, understanding, and following the agency's charity care and collections policies.
• Ensure clients meet eligibility criteria for charity care or discounts based on a percentage of the federal poverty guidelines (which are set by the Department of Health and Human Services to determine financial eligibility for certain federal programs), or the eligibility guidelines used for Housing and Urban Development programs. Charity care and discounts will always be payor of last resort.
• Collaborate with clinics/programs on collection efforts for clients and appropriately identify any patient eligible for charity care funding.
• Ensure financial communication and counseling are clear, concise, correct, and considerate of the needs of patients.
• Verifies eligibility and benefits for all clients.
• Communicating benefit information and co-payments to front office coordinators and reimbursement specialists must be made when needed.
• Maintains confidentiality of patient information.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires Associate's degree, supplemented by (2) years of experience in billing in a medical or behavioral health setting and one (1) year of supervisory experience; or possession of any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principles, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
• Bright/dim light; Dusts and pollen.
• Other extreme hazards not listed above.

Special Certifications and Licenses

• Must possess and maintain a valid state Driver's License with an acceptable driving record.
• Must be able to pass a TB, criminal background and drug screen.

Americans with Disabilities Act (ADA) Compliance

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally competent and recovery-oriented care.
• Responsible for adhering to the EHN common purpose and service framework to continuously provide exceptional care to all constituents.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.