Pre-Services Representative I - Part time - Days - MSS

Memorial Healthcare

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. Summary: 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

ACCOUNTABILITY
ACCURACY
CUSTOMER SERVICE
EFFECTIVE COMMUNICATION
ORGANIZATION SKILLS
PATIENT AND FAMILY CENTERED CARE
PROBLEM SOLVING
PRODUCTIVITY
RESPONDING TO CHANGE
STANDARDS OF BEHAVIOR
TEAM WORK
High School Diploma or Equivalent (Required)
Complexity of Work: Requires excellent communication skills, critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
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.
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.
Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
Input and/or review insurance benefits for the patient account. Re-run estimates when needed to correct expected patient out of pocket liability for that service.
Notifies patient of their financial responsibility for services to be provided. Educate 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.
Perform 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 as well as 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.