[Hiring] Pre-Services Representative - I @Memorial Healthcare

Role Description

Determines and verifies insurance coverage and coordination of insurance benefits from all sources. Requests and/or verifies authorizations for ordered services. Schedules and/or reschedules physician orders for outpatient treatments and/or diagnostic services. Discusses financial responsibilities for upcoming appointments with patient and/or guarantor. Collects upfront payments and/or reviews 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 that service.
• Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
• Confirms insurance coverage.
• Determines necessity for pre-authorization and obtains authorization for that service(s).
• Documents authorization information within the patient account.
• Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
• Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
• 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.
• Handles inbound and/or outbound calls to perform all pre-service functions included but not limited to scheduling, authorizations, benefits, and patient responsibilities.
• Documents appropriate record with the details of the call and the call disposition.

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)

Other Information

• Preferred experience with hospital authorizations and health insurance knowledge.

Working Conditions and Physical Requirements

• Bending and Stooping = 0%
• Climbing = 0%
• Keyboard Entry = 80%
• Kneeling = 0%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 0%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 0%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 80%
• Distinguish Color = 0%
• Seeing - Far = 80%
• Seeing - Near = 80%

Shift

Primarily for office workers - not eligible for shift differential.

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

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, gender identity or expression, 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.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [email protected].