Pre-Service Rep

Ochsner Clinic Foundation•New Orleans, LA

About The Position

The Pre-Service Rep assists patients by communicating with insurance payors through telephone, fax, and internet to determine eligible benefits and obtain pre-certifications when required. The role communicates patient liability after pre-certification and ensures the pre-service process is complete before a patient arrives for scheduled services. The position prepares and validates cases for pre-scheduled services, verifies insurance and demographic information, obtains authorizations, estimates and communicates patient costs, and provides point-of-service information and logistics to support the patient experience. The representative works with clinical providers and the on-site case management team, including LPNs, RNs, and nurse auditors. The role also requires compliance with applicable laws, accreditation standards, regulatory requirements, and the employer’s Compliance & Privacy Program and Standards of Conduct. This is light work involving occasional lifting or moving of up to 20 pounds. The routine does not involve exposure to blood, body fluids, or tissue, and the employee is not expected to provide emergency care or first aid. Because the work is in a healthcare setting, there may be occupational exposure risk involving hazardous medications or waste. Reliable transportation is needed to travel to other facilities as required.

Requirements

High school diploma or equivalent.
At least 1 year of related experience in a hospital, clinic, medical office, business services/revenue cycle, front-line registration, financial counseling, banking, or customer service role.
Computer skills and dexterity for entering and retrieving patient information.
Effective verbal and written communication skills, including the ability to present information clearly and professionally to people at varying levels throughout the patient care process.
Proficiency with Windows-style applications, keyboarding, and software packages specific to the role.
Strong interpersonal skills.
Ability to multitask and work effectively in a fast-paced, changing environment.
Ability to remain calm and professional during high-pressure or stressful patient financial and medical conversations.
Reliable transportation to travel to other facilities to fill in as needed.

Nice To Haves

Associate degree or bachelor's degree.
Experience with EPIC.

Responsibilities

Prepare, validate, and complete the steps needed to clear new cases for pre-scheduled services, including gathering and validating insurance and demographic information.
Contact insurance companies through websites, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
Use the EPIC system to gather information and verify benefits and eligibility.
Complete and obtain all authorizations required for services.
Work with clinical providers, the on-site case management team, and LPNs, RNs, or nurse auditors in the Pre-Service department.
Perform pre-service collection estimates and communicate patient liability.
Provide point-of-service information and logistics to support the patient experience.
Perform other related duties as required.
Stay knowledgeable about applicable federal, state, and local laws, accreditation standards, and regulatory requirements, and ensure compliance.
Immediately report known or suspected unethical or questionable conduct and patient or employee safety, privacy, or other compliance concerns.