Pre-Service Representative- Remote

About the role

This position is responsible for assisting patients by communicating with insurance payors via various methods (telephone, fax, internet) to determine eligible benefits and acquire Pre-Certification(s) when required by the insurance payor. You will communicate patient liability after obtaining Pre-Certification and ensure the Pre-Service process is completed before the patient’s scheduled service.

Responsibilities

• Prepares, validates, and completes all steps necessary to clear new cases for pre-scheduled services, including validating and gathering insurance and demographic information.
• Interacts with insurance companies via website, phone, or fax to verify benefits, obtain authorizations, identify insurance guidelines, and facilitate communication.
• Gathers information to verify benefits and eligibility using the EPIC system.
• Completes and obtains all necessary authorizations for services to be performed, collaborating with clinical providers, on-site case management, LPN/RN, or Nurse Auditor in the Pre-Service department.
• Performs Pre-Service collection estimation functions and communicates patient liability.
• Provides point-of-service information and logistics to ensure an exceptional patient experience.
• Remains knowledgeable on current federal, state, and local laws, accreditation standards, or regulatory requirements applicable to the assigned area and ensures compliance.
• Other related duties as required.

Requirements

• High School diploma or equivalent (required).
• Associate’s Degree or Bachelor’s Degree (preferred).
• 1 year of related experience in a hospital, clinic, medical office, business services/revenue cycle, front-line registration, financial counseling, banking, and/or customer service (required).
• Experience with EPIC (preferred).

Skills

• Computer skills and dexterity for data entry and retrieval of patient information.
• Effective verbal and written communication skills, with the ability to present information clearly and professionally to varying levels of individuals.
• Proficiency with Windows-style applications, keyboard, and role-specific software packages.
• Strong interpersonal skills and ability to multi-task.
• Ability to perform effectively in a fast-paced, ever-changing environment.
• Ability to remain calm and professional in high-pressure or stressful situations involving patient financial and medical conversations.
• Reliable transportation to travel to other facilities as needed.

Physical and Environmental Demands

• Light Work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, with negligible force constantly to move objects.
• Physical demands may include walking or standing to a significant degree, sitting with pushing/pulling of arm or leg controls, or working at a production-rate pace.
• Normal routine involves no exposure to blood, body fluid, or tissue, and no emergency care or first aid responsibilities.
• No occupational risk for exposure to communicable diseases, though there may be risk for exposure to hazardous medications or waste within a healthcare setting.