Pre-Service Representative - SSO Pre-Service -

USA Health Systems; Mobile (AL); On-site; USD 38,000 - 58,000; Full time

Job summary

USA Health in Mobile, AL is seeking an Insurance Verification Specialist to support hospital operations and ensure timely authorization submissions. The role requires a High School Diploma or equivalent and 2 years of insurance verification or precertification experience in a medical setting.

Applicants will interact with EMR systems, payer portals, and internal teams to maintain accurate documentation and prompt responses while following compliance standards and ensuring patient access to

Qualifications

• High School Diploma or equivalent with 2 years insurance verification and/or precertification experience in medical settings (required).
• Comparable combination of education and experience may substitute for the above requirements.

Responsibilities

• Abides by and enforces all compliance requirements and policies.
• Adheres to hospital policies including confidentiality.
• Requires minimal supervision to safely perform essential functions.
• Utilizes proper body mechanics when moving equipment and supplies that are 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, expedites responses from insurance carriers and other payers, and maintains contact with patients, departments and providers to keep them continuously informed.
• Interacts with EMR systems and portals to submit authorization requests electronically to receive timely responses.
• Participates in regular group discussions regarding effectiveness of service by reviewing results, including any denials for reason 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.

Skills

Insurance verification

Education

High School Diploma or equivalent

Job description

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

Responsibilities

• Abides by and enforces all compliance requirements and policies and performs these 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 that are 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, expedites responses from insurance carriers and other payers, and 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 to avoid delays that may interrupt care of therapies
• Obtains clinical, lab and medical testing documentation from at least two EMR's and from paper documentation for submission to payers
• Interacts with all necessary portals to submit authorization requests electronically to receive as timely of responses as possible, using websites and telephone services as needed
• Participates in regular group discussions regarding effectiveness of service by reviewing results, including any denials for reason 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

Additional Information

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

Qualifications

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