Pre-Services Representative
About The Position
Obtains and verifies demographic, confidential clinical and financial information necessary to accurately and efficiently financially secure hospital procedures in a timely fashion. Pre-registers patient, verifies insurance eligibility and benefits, and identifies those services that require an insurance authorization, notification and/or recertification. Completes medical necessity review. Determines estimated financial responsibility. Communicates estimated financial responsibility to patients and collects payment. Adheres to all JCAHO, CMS, and HIPAA requirements when creating a hospital account. Works directly with nurses, medical staff, ancillary departments, insurance carriers, and other external professionals to assist patients with obtaining healthcare and financial services. Assists and educates patients through the process to provide a positive patient experience.
Requirements
- High School Education/GED or equivalent: Required
Nice To Haves
- Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
- Healthcare front office experience: Preferred
- Customer service experience: Preferred
Responsibilities
- Completes patients packets with all necessary forms and documents in preparation for admissions.
- Coordinates admissions activities in order to obtain all necessary patient information for billing, but also any needed by other departments such as medical records.
- Discusses, arranges and receives payment of bills with patient or representative for co-payments and private pay accounts.
- Assists customers with Medicaid/County Medical Services Program (CMSP) applications by evaluating documentation for completeness and accuracy, monitoring their compliance with requirements and establishing appointments with county welfare office.
- Maintains and updates patients accounts for medical and financial eligibility.
- Maintains reports related to case qualifications.
- Obtains all necessary billing, insurance and other demographic information from patient or representative.
- Obtains necessary authorizations for inpatient stays from utilization review.
- Posts payments and corresponding contractual adjustments to patient's accounts.
- Serves as a resource to public providing insurance information and benefits.
- Sets up payment schedules if patients or representative are unable to pay balances in full.
- Performs other job-related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
