Insurance Client Service Rep

Summary Determines and verifies insurance coverage and coordination of insurance benefits from all sources. Requests and/or verifies authorizations for ordered services. Schedule and/or reschedule physician orders for outpatient treatments and/or diagnostic services. Discuss financial responsibilities for upcoming appointments with patient and/or guarantor. Collect upfront payments and/or review for financial assistance. Handles inbound and/or outbound calls related to the above functions.
Responsibilities Inputs and/or reviews insurance benefits for the patient account.
Re-runs estimates when needed to correct expected patient out‑of‑pocket liability for the service.
Handles inbound and/or outbound calls to perform all pre‑service functions including scheduling, authorizations, benefits, and patient responsibilities.
Documents appropriate record with the details of the call and the call disposition.
Notifies patient of their financial responsibility for services to be provided.
Educates guarantor about their out‑of‑pocket responsibility for the service and collects pre‑service payments in accordance with available financial options.
Ensures compliance with departmental procedures for payment.
Documents details of the call and notates any collections that need to be performed at time of registration.
Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
Confirms insurance coverage.
Determines necessity for pre‑authorization and obtains authorization for the service(s).
Documents authorization information within the patient account.
Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
Competencies Accountability
Accuracy
Customer service
Effective communication
Organization skills
Patient and family centered care
Problem solving
Productivity
Responding to change
Standards of behavior
Team work
Education and Certification Requirements High School Diploma or Equivalent (Required).
Additional Job Information Requires excellent communication skills, critical thinking skills, decisive judgment, and ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Required Work Experience No prior experience required.
Preferred Experience Preferred experience with hospital authorizations and health insurance knowledge.
Shift Primarily for office workers - not eligible for shift differential.
Equal Employment Opportunity Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post‑offer, pre‑placement assessment, including drug testing.

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