Pre-Service Rep

Ochsner Health • New Orleans, LA

2d

About The Position

This job assists patients by communicating with insurance payors through telephone, fax, internet, and other methods to determine eligible benefits and obtain pre-certifications when required by the payor. The role communicates patient liability after pre-certification and ensures the pre-service process is completed before patients arrive for scheduled services.

The position prepares and clears cases for pre-scheduled services by validating insurance and demographic information, verifying benefits and eligibility, obtaining authorizations, estimating pre-service collections, and communicating patient liability. It also provides patients with point-of-service information and logistics to support an exceptional patient experience. The role works with clinical providers and the pre-service case management team, including LPNs, RNs, or Nurse Auditors, and must comply with applicable laws, accreditation standards, regulatory requirements, and the employer’s Compliance & Privacy Program.

This position is classified as Light Work. Its normal routine involves no exposure to blood, body fluids, or tissue, and no emergency care or first aid duties. Work in a healthcare setting may involve occupational risk of exposure to hazardous medications or waste. Reliable transportation is required to travel to other facilities as needed.

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 data entry and retrieval of 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, keyboard, and software packages specific to the role.
• Strong interpersonal skills.
• Ability to multitask and perform effectively in a fast-paced, changing environment.
• Ability to remain calm and professional in 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 all steps necessary to clear new cases for pre-scheduled services, including validating and gathering insurance and demographic information.
• Interact with insurance companies by website, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
• Gather information and verify benefits and eligibility using the EPIC system.
• Complete and obtain all necessary authorizations for services, working with clinical providers, the on-site case management team, and LPNs, RNs, or Nurse Auditors in the Pre-Service department.
• Perform pre-service collection estimation functions and communicate patient liability.
• Provide point-of-service information and logistics to support an exceptional patient experience.
• Perform other related duties as required.
• Remain knowledgeable about applicable 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-related concerns.

What This Job Offers

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