Pre-Encounter Representative

Northwestern Medical Center•St. Albans, VT

About The Position

Northwestern Medical Center is recruiting a full-time Pre-Encounter Representative in Patient Access. The role performs ambulatory, outpatient, and inpatient scheduling, pre-registration, registration, payer eligibility, and complex financial clearance in a call-center environment or by floating to medical group and hospital department locations. The representative obtains insurance pre-certification and prior authorization, assists patients and families with financial requirements, estimates and collects point-of-service payments, and provides patient-focused customer service while communicating with clinical departments to support patient flow. The role may also perform Patient Access Representative – Clinic functions as required. Responsibilities include collecting and documenting demographic and financial information, registering and scheduling patients, confirming insurance eligibility and authorizations, explaining benefits and financial obligations, collecting payments, and supporting patients in accessing financial assistance. The representative also coordinates appointments and referrals, manages schedule gaps and waitlists, follows up on no-shows, handles a high volume of inbound and outbound calls, and works with patients and payers to resolve complex eligibility and financial-clearance issues. The position generally works 8:00 a.m. to 4:30 p.m. and is 80 hours bi-weekly. It reports to the Patient Access Supervisor. Work takes place in a medical office environment and involves extended sitting, as well as standing, walking, manual dexterity, and mobility. The role may require pushing a patient in a wheelchair. Equipment includes a computer, basic office equipment, and a multi-line phone system. PPE is used as the patient’s condition or situation dictates.

Requirements

High school diploma or equivalent required.
Basic computer and typing skills required.
Detail-oriented and organized, with the ability to handle multiple tasks and responsibilities and prioritize appropriately.
Basic math skills sufficient to collect money and make change.
Strong communication skills and the ability to communicate professionally and tactfully.
Ability to meet department accuracy and error-resolution standards: greater than 90% Final Accuracy and greater than 75% Error Resolution.
Ability to maintain compliance with HIPAA guidelines and applicable insurance and Medicare requirements.

Nice To Haves

Associate degree preferred.
Prior customer service experience preferred.
Experience in a medical office or hospital setting preferred, but not required.

Responsibilities

Collect pertinent demographic and financial information according to HIPAA guidelines and register or pre-register ambulatory, outpatient, and inpatient visits.
Document registration and pre-registration activities, review work for completeness and accuracy, and direct patients to the correct clinical area.
Obtain necessary patient or guardian signatures and copy or scan both sides of insurance cards and photo identification.
Verify insurance eligibility, ensure required pre-certifications and authorizations are obtained, explain benefits, and collect predetermined self-pay amounts at registration.
Complete Medicare Secondary Payer Questionnaires and check medical necessity for Medicare patients; complete Advance Beneficiary Notices when applicable.
Provide initial counseling about NMC and other financial assistance programs, provide relevant paperwork, and refer patients to Financial Counselors as needed.
Schedule, reschedule, or cancel appointments; enter and review orders and appointment information; schedule incoming referrals; and communicate emergency schedule interruptions.
Prepare patients for appointments by securing and scanning orders, identifying special needs, facilitating authorization, collecting pre-service payments, and ensuring necessary supplies are available.
Manage schedule gaps, maintain appointment utilization, use waitlists to fill openings, and follow up on no-show visits.
Handle a high volume of inbound and outbound phone calls.
Monitor upcoming hospital-based services to ensure required authorizations are established, validate authorizations with payers, and obtain missing authorizations.
Prepare complex procedure estimates and Good Faith Estimates for self-pay patients, and explain expected financial obligations.
Assist underinsured patients by facilitating financial counseling and providing resources for obtaining insurance.
Serve as a resource for complex insurance eligibility and financial estimates, and liaise with patients and payers to resolve eligibility issues.
Coordinate with physician offices and hospital departments to resolve issues and support quality patient encounters and patient flow.
Maintain a clean, orderly workspace and waiting area; use equipment, systems, and supplies appropriately; manage resources effectively; and identify learning needs.
Attend at least 50% of monthly staff meetings and cross-train or work across Patient Access units as required.