PRE-SERVICE REPRESENTATIVE, CENTRALIZED SCHEDULING

About the Organization

At SGMC Health, we focus on three core values:

• Purpose: Every role contributes to goals that improve our community.
• Excellence: We do the right thing the right way, hold ourselves accountable, require competence, and serve with compassion.
• Team Spirit: We encourage teamwork, support personal and professional growth, and foster innovation and empowerment.

SGMC Health is recognized locally, statewide, and nationally for award-winning performance and exceptional care.

Benefits

• Low healthcare insurance premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company-paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

About the Role

This full-time position in Central Scheduling is responsible for all aspects of scheduling inpatient and outpatient procedures, including:

• Recording patients into the lobbying system
• Complete patient registration
• Patient transfers and bed placements across all departments
• Meeting productivity standards of 94% to 105%
• Compliance with HIPAA regulations
• Completion of Medicare questionnaires for each Medicare patient
• Insurance benefit verification and accurate entry of patient demographics and financial data

You will also handle all PayNav functionalities, including:

• Medical necessity checks for Medicare patients
• Cost estimates for each patient
• Insurance verification for all patients
• Striving to reach 100% of your personalized collection goal

Additional responsibilities include:

• Maintaining an accuracy rate of 98% or higher in AHIQA
• Coordinating referrals to appropriate personnel, including Customer Service
• Managing and responding to all SGMC emails, phone calls, and voice messages

Responsibilities

• Ensure accurate and efficient scheduling of inpatient and outpatient procedures
• Verify insurance benefits and enter patient demographics and financial data correctly
• Perform medical necessity checks and provide cost estimates via PayNav
• Maintain high accuracy in data entry and documentation (98% or higher in AHIQA)
• Coordinate account referrals to appropriate personnel
• Respond to and address all communications (emails, phone calls, voice messages)
• Understand and comply with Medicare, Medicaid, and other insurance requirements
• Handle patient transfers and bed placements for all departments

Requirements

• PC and Windows literacy; experience with Series, Trace, PayNav, and Microsoft Office applications preferred
• Extensive knowledge of insurance/managed care, including:
  • Medicare and Medicaid (Georgia and Florida)
  • Peach Care, Tricare (Standard, Extra, Prime), VA, Disability Adjudication Services
  • Vocational Rehabilitation, Children’s Medical Services, Cancer State Aid
  • Crime Victim’s Compensation Program, Knight’s Templar Eye Foundation
  • Managed Care (HMO, PPO, POS, Medicare HMO), COBRA, Worker’s Compensation
  • Georgia Indigent Care Trust Fund, Blue Cross (Georgia, Florida, out-of-state, FEP)
  • Institutional Billing
• Strong verbal communication and customer service skills
• Knowledge of medical terminology, CPT Codes, HCPCS, ICD-10, and PCI compliance
• Understanding of regulatory and legal requirements, including:
  • Medicare Secondary Payer Questionnaire
  • Advance Directives (living wills, healthcare surrogate)
  • Medical necessity checking requirements, ABNs, letters of non-coverage
  • Coordination of benefits
• Thorough understanding of:
  • Patient type and financial class
  • Insurance master, employer codes, clinic codes, physician coding
  • Admission source codes, relationship codes, accommodation codes
  • Special handling codes, medical service codes
• Ability to organize workload efficiently and type 40 WPM accurately
• Previous data entry, programming, or office coordinator experience highly preferred
• College degree or relevant coursework preferred
• CPAR certification preferred

Skills

• Technical/system skills, including proficiency in healthcare software (e.g., PayNav, Series, Trace)
• Strong verbal and written communication
• Excellent customer service and interpersonal skills
• Ability to interact effectively with patients, departments, physician offices, insurance companies, and regulatory agencies
• Knowledge of reimbursement methodologies (percent-of-charges, discounted fee-for-service, fee schedule, cost-based, capitation)

Schedule

Full-time, 8-hour day shift (8:30 AM – 5:00 PM).

Working Conditions

• Modern, well-lighted, air-conditioned office environment with moderate noise levels
• Occasional overtime required
• Potential exposure to blood and body fluids
• Ability to sit, stand, or walk for moderate periods
• Safe operation of office equipment (copier, fax, printers, computer, telephone, etc.)
• Reading printed materials, including physician orders
• Moderately heavy lifting (0-25 lbs.), reaching, stooping, pushing, pulling, bending, and twisting