Pre-Service Representative - USA Industrial Medicine - USA Health Physicians Group

About the role

USA Health is transforming medicine along the Gulf Coast to care for the unique needs of our community. We offer patients convenient access to innovative treatments and advancements that improve health and overall well-being through multiple facilities, campuses, clinics, and classrooms.

Responsibilities

• Abides by and enforces all compliance requirements and policies, performing responsibilities in an ethical manner consistent with the organization's values.
• Adheres to hospital policies, including confidentiality.
• Requires minimal supervision to safely perform essential functions.
• Utilizes proper body mechanics when moving equipment and supplies necessary to perform essential functions.
• Reports broken or malfunctioning equipment to supervisor or manager.
• Initiates requests, follows up to provide additionally required information, tracks progress, and expedites responses from insurance carriers and other payers.
• Maintains contact with patients, departments, and providers to keep them continuously informed.
• Tracks, reports, and escalates service issues arising from requests for authorizations, financial assistance, or other issues that delay service to ensure patient access and avoid interruptions in care or therapies.
• Obtains clinical, lab, and medical testing documentation from at least two EMRs and from paper documentation for submission to payers.
• Interacts with all necessary portals to submit authorization requests electronically, using websites and telephone services as needed to receive timely responses.
• Participates in regular group discussions regarding service effectiveness, including reviewing denials for reasons under the purview of this position.
• Participates in work-group discussions and on committees as assigned.
• Participates in Performance Improvement activities as assigned.
• Completes all mandatory department, educational, and hospital requirements.
• Adheres to current Infection Control and Safety Standards.
• Regular and prompt attendance; ability to work schedule as defined and overtime as required.
• Related duties as assigned.

Requirements

• High School Diploma or equivalent and 2 years of insurance verification and/or precertification experience in a medical office or hospital setting.
• Comparable combination of education and experience may substitute for the above requirements.

Benefits

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.