Pre-Services Representative I - FT - Days - MSS

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

About the role

Determines and verifies insurance coverage and coordination of insurance benefits from all sources. Requests and/or verifies authorizations for ordered services. Schedules and/or reschedules physician orders for outpatient treatments and/or diagnostic services. Discusses financial responsibilities for upcoming appointments with patient and/or guarantor. Collects upfront payments and/or reviews for financial assistance. Handles inbound and/or outbound calls related to the above functions.

Responsibilities

• Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
• Confirms insurance coverage.
• Determines necessity for pre-authorization and obtains authorization for that service(s).
• Documents authorization information within the patient account.
• Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
• Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
• Notifies patient of their financial responsibility for services to be provided.
• Educates guarantor about their out-of-pocket responsibility for the service and collects pre-service payments in accordance with available financial options.
• Ensures compliance with departmental procedures for payment.
• Documents details of the call and notates any collections that need to be performed at time of registration.
• Handles inbound and/or outbound calls to perform all pre-service functions including scheduling, authorizations, benefits, and patient responsibilities.
• Documents appropriate record with the details of the call and the call disposition.
• Inputs and/or reviews insurance benefits for the patient account.
• Re-runs estimates when needed to correct expected patient out-of-pocket liability for that service.

Skills

• Accountability
• Accuracy
• Customer Service
• Effective Communication
• Organization Skills
• Patient and Family Centered Care
• Problem Solving
• Productivity
• Responding to Change
• Standards of Behavior
• Team Work

Qualifications

High School Diploma or Equivalent (Required)

Requires excellent communication skills, critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

No prior experience required.

Preferred experience with hospital authorizations and health insurance knowledge.

Working Conditions and Physical Requirements

• Keyboard Entry: 80%
• Lifting or Carrying 0 - 25 lbs Non-Patient: 60%
• Pushing or Pulling 0 - 25 lbs Non-Patient: 60%
• Repetitive Movement Hand/Arm: 80%
• Sitting: 80%
• Standing: 80%
• Walking: 80%
• Audible Speech: 80%
• Hearing Acuity: 80%
• Depth Perception: 80%
• Seeing - Far: 80%
• Seeing - Near: 80%
• Computer Monitor: 80%