Pre-Services Coordinator (Prior Authorization)

HHC•Indianapolis, IN

2d•Onsite

About The Position

The Pre-Services Coordinator works directly with patients, referring physician offices, and payers to ensure full payer clearance prior to receiving care. This involves pre-registration, financial clearance, authorization, referral validation, and pre-serviceability estimations and collections. The role establishes the first impression of Eskenazi Health for patients, families, and other customers, acting as a subject matter expert on payer requirements, authorizations, appeals, and patient navigation.

Requirements

High School Diploma or GED required.
Certification in Healthcare Business Insights within 60 days of hire.
Understanding of Medicare regulations, Medicaid MRO, Medicaid Clinic Services, and Commercial insurance related to any necessary prior authorization process/requirements.
Advanced computer skills to facilitate the utilization of web based applications.

Nice To Haves

Accredited Bachelor's degree preferred; OR four (4) years experience in a pre-services setting.

Responsibilities

Conducts pre-registration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan codes and Coordination of Benefits orders.
Corrects and updates all necessary data to assure timely, accurate bill submission.
Maintains accountability for accuracy of data collected and entered into systems and demonstrates the ability to maintain the passing grade on monthly audits.
Verifies insurance information through payer contacts via telephone, online resources, or electronic verification systems and identifies payer authorization/referral requirements.
Provides appropriate documentation and follow up to patients, physician offices, case management departments, and payers regarding authorization/referral deficiencies.
Contacts insurance carriers or other sources to obtain prior authorizations; obtains pre-certification and/or authorization prior to services.
Identifies all patient financial responsibilities, calculates estimates, collects liabilities, posts payment transactions, and completes waivers as appropriate in the Epic system.
Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate.
Delivers positive patient experience using AIDET.
Counsels patients regarding insurance benefits by explaining financial responsibilities for services received, payment options, and collections procedures to patients and parties responsible for payment.
Performs any written and verbal communication necessary to exchange information with designated contacts and promote working relationships with patients, Eskenazi Health leadership and staff, physician offices, and external/internal customers.
Initiates process for collecting prepays due and performs follow-up to insure maximum collection is achieved.
Updates and correctly documents in Epic.
Attains productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.
Attains quality standards, recommending new approaches for enhancing quality when appropriate.