About The Position

The Pre Services Representative is engaged in one or more of the revenue cycle roles including: pre-service scheduling and patient access, pre-registration, insurance verification, financial clearance and denial management. Hours Full time 40 hours/week, 8:30a - 5:00p. Education High school diploma or equivalent (GED).

Requirements

  • Must have prior knowledge and expertise in insurance policies and coverage and medical necessity and prior authorization requirements.
  • Minimum of three years experience in a healthcare or related environment also required.
  • Working knowledge of medical terminology, Microsoft Office applications and the ability to navigate in a Windows based environment.
  • Must have proven exceptional communication skills, critical thinking and problem solving skills, and interpersonal skills.
  • The successful candidate will be part of a 16 plus member team so must be able to work well in a team environment and possess ability to work independently as well.

Responsibilities

  • Performs insurance authorization for elective outpatient radiology imaging and cardiovascular testing.
  • Schedules, reschedules and cancels appointments and enters data into Schapptbook accordingto program logic and SchedulingGuidelines.
  • Handles phone calls in a professional and efficient manner adhering to department call standards for Pre Services.
  • Using appropriate schedules and work lists verifies insurance benefits and approvals for outpatient imaging, elective procedures and surgical cases and urgent/emergent admissions.
  • Notify Payers of patient admissions/placed in observation as required by payers.
  • Manages Faxes received in the Work Queue Monitor Program.
  • Communicates and responds to patients, provider(s), payers and other associates/business partners and joint ventures using available tools (Message Center in PowerChart, email/secure email or phones) to ensure accurate scheduling of appointments and billing of encounters
  • Researches and responds to requests for cost of care.
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