Pre-Service Specialist

Carolinas Medical Center; United States; Remote; USD 30,000 - 45,000; Full time

Benefits offered by this job

Total rewards

Paid time off

Health benefits

Retirement offerings

Job summary

Carolinas Medical Center is seeking a Remote Pre-Service Insurance Clearance Specialist to verify patient demographics and insurance details, perform eligibility checks, and document required information. The role involves calculating patient liabilities and communicating financial obligations to patients.

You will also coordinate pre-certifications, referrals, and authorizations when needed, educate patients on payment expectations, and support scheduling through the EPIC system.

Qualifications

• High School diploma required.
• Typically 1 year of experience in health care, insurance, call center or customer service.
• Knowledge of Medicare/HIPAA/EMTALA rules and updates.
• Mathematical aptitude and strong communication skills.
• Experience with EPIC EMR and insurance verification tools.

Responsibilities

• Verify patient demographics and insurance information.
• Document initial pre-certification/authorization information and initiate referrals.
• Estimate patient liabilities and discuss financial obligations with patients.
• Inform physicians and patients about payment expectations and potential rescheduling.
• Schedule patient visits and manage the EPIC Scheduled Order queue.

Skills

Insurance verification

EPIC EMR

Customer service

Microsoft Office

Communication skills

Education

High School Diploma

Tools

EPIC

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

Hou rs 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 e