Pre-Services Representative - I - FT - Days - Hybrid - MSS

Memorial Healthcare

76d

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. The position involves determining and verifying insurance coverage and coordination of insurance benefits from all sources. Responsibilities include requesting and/or verifying authorizations for ordered services, scheduling and/or rescheduling physician orders for outpatient treatments and/or diagnostic services, discussing financial responsibilities for upcoming appointments with patients and/or guarantors, and collecting upfront payments while reviewing for financial assistance. The role also includes handling inbound and/or outbound calls related to these functions.

Requirements

• High School Diploma or Equivalent (Required)
• Excellent communication skills
• Critical thinking skills
• Decisive judgment and the ability to work with minimal supervision
• Ability to work in a stressful environment and take appropriate action

Nice To Haves

• Preferred experience with hospital authorizations
• Health insurance knowledge

Responsibilities

• Notifies patient of their financial responsibility for services to be provided.
• Educates guarantor about their out of pocket responsibility for the service and collects pre-service payments in accordance with available financial options.
• Ensures compliance with departmental procedures for payment.
• Documents details of the call and notates any collections that need to be performed at time of registration.
• Handles inbound and/or outbound calls to perform all pre-service functions including scheduling, authorizations, benefits, and patient responsibilities.
• Documents appropriate record with the details of the call and the call disposition.
• Inputs and/or reviews insurance benefits for the patient account.
• Re-runs estimates when needed to correct expected patient out of pocket liability for that service.
• Performs job duties outside of Pre-Services within the Revenue Cycle areas.
• Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
• Facilitates the coordination of training and/or quality assurance of new and current employees.
• Develops and mentors staff to align with departmental goals and acts as a resource for internal/external departments.
• Confirms insurance coverage.
• Determines necessity for pre-authorization and obtains authorization for that service(s).
• Documents authorization information within the patient account.
• Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
• Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees