Insurance & Pre-Registration Representative, FT, Days

Prisma Health • Greenville, SC

1d

About The Position

The Insurance & Pre-Registration Representative verifies insurance coverage, benefits, and current patient responsibility using online eligibility tools, websites, or telephone inquiries to insurance administrators and third-party payors. The representative documents insurance verification accurately and completely in the EPIC patient billing system and ensures insurance priorities are correct based on third-party requirements and coordination of benefits.

The role initiates, obtains, and documents pre-certifications and prior authorizations according to departmental guidelines. It also identifies and communicates new insurance system issues to appropriate personnel and manually corrects or updates identified insurance issues according to departmental guidelines until a system correction can be implemented. This is a non-management position reporting to a supervisor, manager, director, or executive.

Requirements

• High school diploma or equivalent, or a post-high-school diploma or highest degree earned.
• Two years of billing, bookkeeping, or accounting experience.
• Maintain up-to-date knowledge of current insurances, including which plans run through the system, how to fix system errors, and how to verify eligibility and benefits for insurances that do not run through the system.
• Maintain up-to-date knowledge of current managed care contracts and use the correct network or out-of-network status for each insurance.

Responsibilities

• Verify insurance coverage and benefits through online eligibility tools, websites, or telephone inquiries to insurance administrators and third-party payors.
• Accurately and completely document insurance verification information in the EPIC patient billing system.
• Ensure insurance priorities are correct based on third-party requirements and coordination of benefits.
• Identify current patient responsibility using insurance eligibility and benefit responses, and document it according to departmental guidelines to support collection of correct payments at the time of service.
• Initiate, obtain, and document pre-certifications and prior authorizations according to departmental guidelines.
• Communicate new insurance system issues to appropriate personnel for review and correction.
• Manually correct or update identified insurance issues according to departmental guidelines until a system correction can be implemented.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED