Pre-Service Specialist

Hugh Chatham Health, Inc.; Milwaukee (WI); Remote; USD 30,000 - 45,000; Full time

Benefits offered by this job

Paid Time Off

Health benefits

Flexible Spending Accounts

Family benefits

Retirement plan with employer match

Educational Assistance Program

Job summary

Advocate Health seeks a Remote Insurance Verification Specialist in Wisconsin. You will verify patient demographics and insurance, check eligibility, document liabilities, and initiate referrals where needed. The position supports scheduling and uses EPIC for order processing.

Requires one year in health care or insurance settings, strong communication, and HIPAA knowledge. Excellent patient relations and a proactive problem-solving attitude are essential.

Qualifications

• Demonstrated understanding of Medicare/HIPAA rules and pre-certification requirements.

Responsibilities

• Verify patient demographics and insurance information.
• Document eligibility checks and patient liability.
• Obtain/record pre-certification information and referrals.
• Explain patient financial obligations and payment expectations.
• Schedule visits and complete EPIC questionnaires.

Skills

Insurance verification

HIPAA compliance

Customer service

Verbal communication

EPIC EMR

Microsoft Office

Education

High School Diploma

Tools

EPIC EMR

Insurance verification tools

Microsoft Office

Job description

Department

10340 Rehabilitation Services: WI - PreService Insurance Clearance WI IL Auth PCC

Status

Full time

Benefits Eligible

Yes

Hours Per Week

40

Schedule Details/Additional Information

M-F, 7:30-4, REMOTE

Pay Range

$21.85 - $32.80

Major Responsibilities

• Contacts the patient to obtain/validate demographics and insurance information. Completes insurance verification and eligibility checks and documents patient liability.
• Collects and accurately documents initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
• Calculates patient liabilities based on scheduled procedures and previous balances. Informs the patient of his/her liability and discusses financial obligations with the patient including requesting payment.
• Communicates to physician office/patient the organization expectation of payment and/or having an authorization on file prior to service, explaining service may be re-scheduled.
• Schedule patient visits using guidelines established within scheduling system. Recognizes exceptional scheduling situations and escalates as necessary. Completes necessary online EPIC questionnaires needed to complete scheduled exam.
• Provides accurate, detailed information regarding test preparations, time of patient arrival and any other directional information.
• Works assigned EPIC Scheduled Order Work Queue, following the department’s work flow process on appropriately transferring, deferring or removing orders from the work queue.
• Proactively communicates issues involving customer service and process improvement opportunities to management.
• Maintains excellent public relations with patients, families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
• Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.

Licensure, Registration, And/or Certification Required

• None Required.

Education Required

• High School Graduate.

Experience Required

• Typically requires 1 year of experience in health care, insurance industry, call center or customer service setting.

Knowledge, Skills & Abilities Required

• Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
• Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
• Mathematical aptitude, effective communication skills and critical thinking skills.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
• Ability to speak effectively to customers or employees of organization, maintaining a pleasant, professional demeanor.
• Ability to handle sensitive and confidential information according to internal policies.
• Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
• Demonstrated technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.

Physical Requirements And Working Conditions

• Must be able to sit the majority of the workday.
• Occasionally lifts up to 10 lbs.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment To You

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits And More

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.