Pre-Visit Specialist I - Call Center Hybrid

Augusta Health • Fishersville, VA

11d • Hybrid

About The Position

Pre-Visit Specialist I provides scheduling, pre-registration and other pre-visit revenue cycle services and a variety of general information requested by our customers. Provide aforementioned services for various service lines and modalities across the organization per physician orders/referrals and / or customer calls or inquiries with an emphasis on exceptional customer experience. Schedules appointments in accordance with physician and / or patient requests with emphasis on filling first available appointment and considering payer pre-authorization time-frames. Inform patients of any/all necessary pre-procedure preparations including any procedure pre-requisite requirements. This position plays a critical role in supporting Augusta Health’s mission and advancing departmental goals through measurable performance indicators and service excellence. This position contributes to a collaborative, patient-centered environment and helps drive outcomes aligned with organizational priorities.

Requirements

• High School Diploma or GED
• Eligibility to work in the United States and meet Virginia state employment requirements

Nice To Haves

• Certification through AAHAM, AAPC, HFMA or other nationally recognized revenue cycle association is desired, can be obtained on the job.
• Medical or accounting experience
• Knowledge of third party and governmental billing/collection techniques.
• Prior experience in a hospital, healthcare system, or related service-oriented environment
• Familiarity with Augusta Health’s systems, workflows, or organizational culture is a plus
• Excellent computer and communication skills
• Adaptable to change
• Ability to problem solve
• Strong time management
• Experience in Microsoft Office products
• Proactively prioritize needs
• Articulates knowledge and understanding of organizational policies, procedures and systems
• Work closely and professionally with all other staff members
• Seeks to model process improvement
• Identifies and reports potential issues at time of discovery

Responsibilities

• Working daily tasks generated within any/all of the departments receivables management computer systems including assigned pre billing edit rejected claims and unpaid denied claims through identifying, documenting and following up on problematic issues that prevented the successful and timely transmission of accurate/clean claims by a third party support partner as well as following up on denied claims by governmental and other third-party payers as assigned in the work queue.
• Identifying and resolving invalid or missing claim data by communicating with the physician office practices, hospital clinical departments, compliance representatives, billing support personnel and/or other constituents to secure and correct the data which prevents or compromises the accurate transmission of the claim to the payer.
• Overseeing assigned accounts receivable to ensure claims are being processed to completion through proactive generation of aging reports, processing of unclean claims in a timely manner in the claims scrubbing system, and accurate and timely follow up on unresolved claims through communications with third party payers and patients, including electronic and verbal communication channels.
• Troubleshooting issues that surface to ensure timely resolution.
• Monitoring claims for denial trends and informing management, office staff, physicians, department leaders, and Revenue Cycle leadership.
• Maintaining a working knowledge of all payer standard transaction sets, such as 837 electronic claims processes, 835 electronic remittances processes and code sets, and electronic fund transferring, to ensure timely deposits of electronic payments.
• Ensuring timely accounts resolution and optimization of cash flow through knowledge of the appeals process in researching denied claims to resolve discrepancies and correct claim data for re-billing.
• Maintaining working knowledge of multiple systems used in the day-to-day functions of the centralized business office.
• Prompt response to payer and patient correspondence.
• Providing regular feedback to management related to payer issues, provider office issues, and any other issues that will delay payment of claims.
• Ability to understand trends versus one off situations that may become a pattern.
• Keeping informed of new federal and state billing regulations any guidelines and reporting any issues to leadership.
• Meeting productivity standards as set by departmental policy in the areas of quantity of work and quality of work.
• Other duties as assigned by Hospital and Physician Billing Manager, or Patient Accounting Director.

Benefits

• Comprehensive insurance package including medical, dental, and vision coverage
• Retirement savings plans and financial wellness support programs
• Generous paid time off and flexible scheduling to promote work-life balance
• Career development programs including clinical ladders, shared governance, and advancement opportunities
• Personalized onboarding with dedicated preceptors and ongoing educational support
• Tuition reimbursement and access to onsite childcare
• Free onsite parking, 24/7-armed security for your safety, a Health Fitness Reimbursement Program, and an onsite credit union and pharmacy
• Competitive pay with shift/weekend differentials
• Employee discounts at the cafeteria, gift shop, pharmacy, and local entertainment venues (i.e., movie tickets)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED