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

Memorial Healthcare

20h•Hybrid

About The Position

Determines and verifies insurance coverage and coordination of insurance benefits from all sources. Requests and/or verifies authorizations for ordered services. Schedule and/or reschedule physician orders for outpatient treatments and/or diagnostic services. Discuss financial responsibilities for upcoming appointments with patient and/or guarantor. Collect upfront payments and/or review for financial assistance. Handles inbound and/or outbound calls related to the above functions.

Requirements

High School Diploma or Equivalent (Required)
No prior experience required.

Nice To Haves

Preferred experience with hospital authorizations and health insurance knowledge.

Responsibilities

Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
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.
Document details of the call and notate any collections that need to be performed at time of registration.
Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
Handles inbound and/or outbound calls to perform all pre-service functions included but not limited to scheduling, authorizations, benefits, and patient responsibilities.
Documents appropriate record with the details of the call and the call disposition.
Confirms insurance coverage.
Determines necessity for pre-authorization and obtains authorization for that service(s).
Documents authorization information within the patient account.
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.
Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).