UW HEALTH POSITION DESCRIPTION

POSITION SPECIFICS
Title: Rehabilitation Prior Authorization Coordinator / Department/Number: Rehabilitation 88220
Reports to: Mgr OrthoRehab Pt Access
Job Code: 6429 / FLSA Status: Non- Exempt
Manager Approval: Date: K. Traino 10-16 / HR Approval: CMW 10-16
POSITION SUMMARY
The Rehabilitation Prior Authorization Coordinator (RPAC) is a position residing in the Rehab Department. Under the guidance of the Manager of OrthoRehab Patient Access, the RPAC works closely with the Outpatient Rehab Director, Managers and the Administrative Supervisor. The Rehabilitation Prior Authorization Coordinator serves as a team lead and will provide day to day guidance and direction to the Rehab Prior Authorization Specialists (RPAS). The RPAC is responsible for completing necessary functions to ensure optimal reimbursement for Rehab services across all the Rehab disciplines to include outpatient PT, OT, SLP, LAT, and Orthotics. These prior authorizations require knowledge of the Rehab disciplines in addition to the specialty areas of Orthopedics; Pediatrics; Neurology; and Orthotics. The RPAC is primarily responsible for conducting and completing necessary third party (insurance) prior authorization requests and associated services related to these services, maximizing efficiency for patients and clinic staff. Other areas of responsibility include pre-screening patients for viable payment sources, and managing reimbursement issues associated with DME and poorly reimbursed services. This person will also identify opportunities for improving reimbursement from payers, maintain and compile reports for optimal 3rd party reimbursement and provide guidance to providers to complete the necessary paperwork for prior authorization. RPAC will simplify prior authorization requirements for the providers as much as possible. RPAC will conduct retrospective utilization reviews on cases payment denials or insufficient reimbursement. This position will help to assure seamless communication between clinics and other departments and will liaison with the Administrative Supervisor on issues needing to be further problem solved with the Billing department and Access Services.
Responsibilities also include maintaining the department charge master file and keeping up to date on coding and reimbursement issues pertaining to the Department.
A wide variety of internal and external relationships are inherent to the success of this position. The incumbent interacts with hospital employees on multiple levels, including Rehab department clinical staff, Rehab department administrative staff, the Administrative Supervisor, the Budget Analyst, the Rehab Director medical/clinical staff of other departments, fiscal personnel, department managers, access services staff, coding staff and billing assistants. External contacts include third party payers, , and referring physician clinics. Strong communication skills, problem-solving abilities, and a professional presentation are imperative along with an ability to be innovative and creative. To be effective, this position must be able to establish collaborative working relationships.
The incumbent acts independently with the help of general policies and procedures and practice guidelines to facilitate the processes with support from the Manager of OrthoRehab Patient Access, Rehab Director, the Administrative Supervisor, the Budget Analyst, the department managers and the Rehab providers.. This position has independent responsibility for organizing and planning work in order to accomplish daily responsibilities as well as broad goals and objectives.
A substantial portion of the normal duties of the incumbent requires proper judgment, sensitivity and strict adherence to University of Wisconsin Hospital and Clinics policy on confidentiality.
MAJOR RESPONSIBILITIES
The incumbent performs the following job responsibilities:
A.  Coordinate Rehabilitation Prior Authorization Specialist (RPAS) staff across the Rehab Department to provide similar training (development of training manuals), skill set, IS needs, websites, online insurance resources and staffing of prior authorization expertise in the Department for managers and providers Monday – Friday 7am – 5 pm.
B.  Provide input into performance appraisals to the Manager of OrthoRehab Patient Access the manager of the RPAS.
C.  Establish a plan for coverage of prior authorization via work queue management with the Prior Authorization Coordinator and the Prior Authorization Specialists to cover all areas. As resources do not meet demands, develop a business plan for changes for Director.
D.  Pursue claim appeals when applicable. Maintain an ongoing tracking spreadsheet. Present data annually to Director.
E.  Maintain a current list of 3rd party payer prior authorization requirements for completion by Admin and provider staff.
F.  Establish a protocol for completion of prior authorization requirements for all new evaluations for the Rehab Dept and delegate processes as needed to other Admin staff.
G.  Establish a protocol for tracking and completion of prior authorization for requests for prior authorization for Rehab following the new evaluation with appropriate collection of clinical data.
H.  Establish a tracking mechanism for referrals within Health Link for all necessary 3rd party payers visible to schedulers and providers. Establish working with Mgr of OrthoRehab Pt Access, Administrative Supervisor, Access Services and Registration.
I.  Maintain updated coding and reimbursement knowledge in the field of Rehab Therapies & Orthotics.
J.  Work closely with providers, Mgr of OrthoRehab Pt Access, Admin Supervisor, Director, Managers, Budget Analyst and Coding department to assist and provide feedback to the coding department with issues regarding new Rehab procedures needing a procedure code and an accurate price; poor reimbursement of a rehab code; denials of a rehab code and suggestions of correct pricing of rehab codes based on clinical activity.
K.  Maintain department charge master with budget analyst, by assigning new charge codes as needed, working with Health Link staff to assure proper placement of codes in billing screens, maintaining charge code file with current pricing and workload values and assisting with annual rate change exercise. Act as resource to staff with questions regarding billing and coding.
L.  Utilize Visio to diagram workflows. Utilize ‘Plan Do Check Act’ process improvement method to assess success of new work flows and evaluate metrics. Work with Patient Access to run reports on decreased write offs annually.
M.  Other duties as assigned.
All duties and requirements must be performed consistent with the UW Health Organizational Performance Standards.
POSITION REQUIREMENTS
Education /

Minimum

/ High school diploma or equivalent

Preferred

/ Bachelor’s degree in relevant field
Work Experience /

Minimum

/ Bachelor’s degree with one (1) year relevant experience, or high school diploma with four (4) years relevant experience

Preferred

/ Experience with front end revenue cycle functions (i.e. insurance verification, prior authorization). Rehabilitation clinic experience.

Licenses & Certifications

/

Minimum

Preferred

/ CPR
Required Skills, Knowledge, and Abilities / ·  Excellent oral and written communication skills and ability to maintain confidentiality of sensitive information.
·  Experience with UWHC’s computer systems (clinical and financial) preferred.
·  Rehabilitation clinic experience preferred.
·  Demonstrated expertise in complex problem solving.
·  Extensive knowledge base in insurance and prior authorization.
·  Experience in explaining an organization’s reimbursement requirements desired
·  Self motivation, initiative, and decision making skills
·  Effective interpersonal skills which foster a team approach to problem solving and ensure high degree of customer satisfaction.
·  Ability to act professionally.
·  High energy, flexible, optimistic attitude with ability to handle multiple demands.
·  Demonstrates an aptitude and willingness to assume additional responsibility and a coordinating role with and across work groups.
·  Displays a consistently approachable demeanor toward patients and staff. Maintains an objective and unbiased approach toward personnel and issues, while upholding the mission, values and polices of UWHC.
·  Promotes a commitment to quality and supports decisions in all aspects of the position to produce results which are beneficial to the operation of the department and UWHC.
·  Windows application knowledge.
Job Function
Review the employee’s job description, and identify each essential function that is performed differently based on the age group of the patient.
PHYSICAL REQUIREMENTS
Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals with disabilities to perform the essential functions of this position.
Physical Demand Level / Occasional
Up to 33% of the time / Frequent
34%-66% of the time / Constant
67%-100% of the time
X / Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met. / Up to 10# / Negligible / Negligible
Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be a negligible amount, a job is in this category when it requires walking or standing to a significant degree. / Up to 20# / Up to 10# or requires significant walking or standing, or requires pushing/pulling of arm/leg controls / Negligible or constant push/pull of items of negligible weight
Medium: Ability to lift up to 50 pounds maximum with frequent lifting/and or carrying objects weighing up to 25 pounds. / 20-50# / 10-25# / Negligible-10#
Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds. / 50-100# / 25-50# / 10-20#
Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds. / Over 100# / Over 50# / Over 20#
List any other physical requirements or bona fide occupational qualifications: