Pre-Service Specialist
About The Position
The Pre-Service Specialist contacts patients to obtain and validate demographic and insurance information, verifies insurance eligibility, documents patient liability, and collects initial pre-certification or authorization information. The specialist initiates requests for required referrals or authorizations and explains financial obligations and payment expectations to patients and physician offices, including when services may need to be rescheduled. The role schedules patient visits according to established guidelines, completes required EPIC questionnaires, provides exam preparation and arrival instructions, and works assigned EPIC Scheduled Order Work Queue items according to department procedures. The specialist communicates customer-service concerns and process-improvement opportunities and collaborates with patients, families, physician offices, and clinical staff to support timely information flow. The position maintains current knowledge of Medicare, Medicaid, third-party payer requirements, insurance plans, and authorization policies. It is a full-time, remote position with a Monday–Friday schedule from 7:30 a.m. to 4:00 p.m., totaling 40 hours per week. The listed pay range is $21.85–$32.80 per hour.
Requirements
- High school graduate.
- Typically requires one year of experience in health care, the insurance industry, a call center, or a customer-service setting.
- Ability to identify and understand issues and problems, examine data, and draw logical conclusions.
- Knowledge of and ability to explain Medicare, HIPAA, and EMTALA rules and regulations and keep current with insurance pre-certification requirements.
- Mathematical aptitude, effective communication, and critical-thinking skills.
- Understanding of basic human anatomy, medical terminology, and procedures as applied to patient referral, pre-certification, and authorization processes.
- Ability to read and interpret safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to communicate effectively and maintain a pleasant, professional demeanor with customers and employees.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem-solve in a high-profile, high-stress area; work independently; set and meet deadlines; and prioritize work.
- Technical proficiency with insurance verification and eligibility tools, EPIC electronic medical record, patient-liability estimation tools, Microsoft Office, Internet Explorer, and phone technology.
- Able to sit for the majority of the workday and occasionally lift up to 10 pounds.
- Operate all equipment necessary to perform the job.
Responsibilities
- Contact patients to obtain and validate demographic and insurance information.
- Complete insurance verification and eligibility checks and document patient liability.
- Collect and document available initial pre-certification or authorization information; initiate requests for required referrals or authorizations.
- Calculate patient liabilities based on scheduled procedures and previous balances, explain financial obligations, and request payment.
- Communicate payment expectations and authorization requirements to physician offices and patients, including the possibility of rescheduling services.
- Schedule patient visits using established guidelines and escalate exceptional scheduling situations as needed.
- Complete online EPIC questionnaires required for scheduled exams.
- Provide accurate test preparation, arrival-time, and directional information to patients.
- Work assigned EPIC Scheduled Order Work Queue items by transferring, deferring, or removing orders according to department workflow.
- Communicate customer-service issues and process-improvement opportunities to management.
- Maintain effective public relations and collaborate with patients, families, and clinical staff to support timely information flow.
- Maintain knowledge and reference materials regarding Medicare, Medicaid, third-party payer requirements, pre-authorization and referral requirements, and accepted insurance plans.
Benefits
- Paid time off programs
- Medical, dental, vision, life, and short- and long-term disability benefits
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match
- Financial wellness programs
- Educational Assistance Program
- Competitive compensation
- Premium pay for eligible shifts, on-call work, and other qualifying circumstances
- Incentive pay for select positions
- Opportunity for annual performance-based increases
- Career development programs
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
