Pre-Services Representative - I - Hybrid - FT - Days - MSS

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

• Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
• 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.
• Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
• 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.
• Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for that service(s). Documents authorization information within the patient account.
• 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.
• Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.

Competencies

Accountability, accuracy, customer service, organization skills, problem solving, productivity, responding to change, standards of behavior.

Additional Job Information

Complexity of Work: Requires excellent communication skills, critical thinking skills, decisive judgment and the 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 with hospital authorizations and health insurance knowledge.