Pre-Services Representative

Job Title

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Obtains and verifies demographic, confidential clinical and financial information necessary to accurately and efficiently financially secure hospital procedures in a timely fashion. Pre-registers patient, verifies insurance eligibility and benefits, and identifies those services that require an insurance authorization, notification and/or recertification. Completes medical necessity review. Determines estimated financial responsibility. Communicates estimated financial responsibility to patients and collects payment. Adheres to all JCAHO, CMS, and HIPAA requirements when creating a hospital account. Works directly with nurses, medical staff, ancillary departments, insurance carriers, and other external professionals to assist patients with obtaining healthcare and financial services. Assists and educates patients through the process to provide a positive patient experience.

Job Requirements:

Education and Work Experience:

• High School Education/GED or equivalent: Required
• Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
• Healthcare front office experience: Preferred
• Customer service experience: Preferred

Essential Functions:

• Completes patients packets with all necessary forms and documents in preparation for admissions. Coordinates admissions activities in order to obtain all necessary patient information for billing, but also any needed by other departments such as medical records. Discusses, arranges and receives payment of bills with patient or representative for co-payments and private pay accounts.
• Assists customers with Medicaid/County Medical Services Program (CMSP) applications by evaluating documentation for completeness and accuracy, monitoring their compliance with requirements and establishing appointments with county welfare office.
• Maintains and updates patients accounts for medical and financial eligibility. Maintains reports related to case qualifications. Obtains all necessary billing, insurance and other demographic information from patient or representative. Obtains necessary authorizations for inpatient stays from utilization review.
• Posts payments and corresponding contractual adjustments to patient's accounts. Serves as a resource to public providing insurance information and benefits. Sets up payment schedules if patients or representative are unable to pay balances in full.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.