Pre-Service Rep

Ochsner Health•New Orleans, LA

About The Position

This role assists patients by communicating with insurance payors through telephone, fax, and online channels to determine benefit eligibility and obtain required pre-certifications. After pre-certification, the representative communicates the patient’s financial liability and ensures the pre-service process is completed before the patient arrives for scheduled services. The position works with clinical providers, case management, and nursing staff to clear cases and support an exceptional patient experience. The representative must follow applicable federal, state, and local laws, accreditation standards, and regulatory requirements. The employer’s Compliance & Privacy Program and Standards of Conduct require reporting known or suspected unethical conduct and concerns related to patient or employee safety, privacy, or compliance. The position is classified as Light Work. Routine work involves no exposure to blood, body fluids, or tissue, and the incumbent is not called upon to assist with emergency care or first aid. There may be occupational risk of exposure to hazardous medications or waste in the healthcare environment, depending on essential duties.

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-related 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, keyboards, 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 conversations about patient finances and medical matters.
Reliable transportation to travel to other facilities to provide coverage as needed.

Nice To Haves

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

Responsibilities

Prepare, validate, and complete steps needed to clear new cases for pre-scheduled services, including gathering and validating insurance and demographic information.
Contact insurance companies by website, telephone, 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 needed for scheduled services.
Coordinate with clinical providers, the on-site case management team, and LPNs, RNs, or Nurse Auditors in the Pre-Service department.
Estimate pre-service collections and communicate patient liability.
Provide point-of-service information and logistics to support the 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 concerns.