Pre-Service Rep

Job Title

This job is responsible for assisting patients by communicating with insurance payors via various methods (i.e. telephone, fax, internet) to determine eligible benefits and acquiring Pre-Certifications when deemed necessary by the insurance payor. Additionally responsible for communicating the liability to the patient after the Pre-Certification has been obtained and ensuring the Pre-Service process has been completed in advance of the patient's arrival for scheduled services.

Education

Required High School diploma or equivalent

Preferred Associates Degree or Bachelor Degree

Work Experience

Required 1 year related experience inf related hospital, clinic, medical office, business services/revenue cycle, front line registration, financial counseling, banking and/or customer service related job

Preferred Experience with of EPIC

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of patient information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Must be proficient with Windows-style applications, keyboard, and various software packages specific to role.
• Strong interpersonal skills.
• Ability to multi-task.
• Ability to perform effectively in a fast paced ever changing environment.
• Ability to remain calm and professional in high pressure/stressful situations regarding patient financial and medical conversations.
• Reliable transportation to travel to other facilities to fill in as needed.

Job Duties

• Prepares, validates and completes all steps necessary to clear new cases for pre-scheduled services. This includes, but is not limited, to validating and gathering insurance and demographic information.
• Interacts with insurance companies via, website, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
• Gathers information to verify benefits and benefits eligibility by utilizing the EPIC system.
• Completes and obtains all necessary authorizations for the service(s) to be performed. Works with the clinical providers, on- site case management team, as well as LPN/RN or Nurse Auditor in the Pre-Service department.
• Performs Pre-Service collection estimation functions and communicates patient liability.
• Provides point of service information and logistics to ensure an exceptional patient experience.
• Other related duties as required.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

The incumbent has no occupational risk for exposure to communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.

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