Pre Service Specialist 1 - (FT, Days)

Health Quest Systems Inc; Danbury (CT); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Medical, Dental and Vision Coverage

Health Savings Account

401(k) Retirement Plan

Wellness Programs

Employee Assistance Program

Team Member Discounts

Basic Life and AD&D insurance

Job summary

Health Quest Systems Inc in Danbury, CT, seeks a full-time referral/central access specialist for patient flow, scheduling, and financial clearance. The role includes pre-registration, insurance verification, and coordination of authorizations to ensure prompt payment.

The position is hybrid-remote with the first 90 days on site. Requirements include a HS Diploma, NAHAM certification within a year, and strong customer service skills.

Qualifications

• HS Diploma required; 2 years of related experience.
• NAHAM certification within one year of hire.
• Basic MS Word & MS Excel; strong customer service and organization.
• Associate's degree preferred with 6 months related experience.

Responsibilities

• Schedule patients for hospital or medical group services via calls, online requests, or outreach.
• Use central referral system to schedule internal and external referrals for continuity of care.
• Provide excellent customer service to physician offices and patients; reduce call metrics.
• Verify insurance eligibility and collect benefit information; use estimation tools.
• Initiate authorizations and follow up with payers to secure payments.
• Perform pre-registration with demographic verification and insurance details; collect liabilities.
• Safeguard patient privacy; comply with all regulations and policies.
• Perform other duties as assigned.

Skills

Customer service

Organizational skills

MS Word

MS Excel

Education

HS Diploma

Associate's degree preferred

NAHAM Certification

Tools

MS Word

MS Excel

Job description

Full-Time: Monday-Friday 9:30am-6:00pm. Hybrid-Remote. First 90 days on site in Danbury, CT.

Northwellis the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees —including members ofNorthwell Health Physician Partners— who are working to change health care for the better.

Summary:

Facilitates patient flow through the referral, scheduling, and financial clearance process. Responsible for obtaining demographic and financial information to ensure accurate patient identification and to secure reimbursement. Performs pre-registration functions and insurance eligibility verification. Provides estimates for services. Requests and secures payments.

Responsibilities:

• May be assigned to schedule patients for hospital or medical group services by incoming phone calls, online requests, or outbound to patients.
• May be assigned to work within the central referral management system to identify and schedule specialist and primary care referrals to NHMP practices as well as external providers when appropriate, with the goal of promoting in-system retention of patients and continuity of care.
• Provides excellent customer service both to physician offices and patients. Contributes to reduction of abandoned call rate, length of calls, and average speed answered through use of best practices and workflow improvements as defined by management. Receives incoming faxed physician orders. Verifies orders for compliance and accuracy.
• Performs insurance eligibility verification and executes payer requirements as needed. Obtains accurate insurance benefit information from payers, such as deductible, copay, and coinsurance amounts. Utilizes patient estimation tool to calculate estimate of patient liabilities. Requires an understanding of coding, procedural protocols and the charge description master.
• Initiates requests for authorizations, pre-certifications, notices of admission, and referrals from insurance companies. Follows up with payers and providers to ensure that authorizations are in place. Takes appropriate steps to remediate situations in which financial clearance is not completed to ensure that Nuvance Health receives prompt payment for services rendered.
• Contacts patients to perform pre-registration, including demographic verification, conveyance of insurance benefits, and estimates of liabilities. Collects on such liabilities prior to time of service utilizing provided scripting. Refers patients who express financial hardship to Financial Counseling for a financial assessment.
• Safeguards patient confidentiality by adhering to all department, organization, state, and federal compliance guidelines. Fulfills all compliance responsibilities related to the position.
• Performs other duties as assigned.

Education Skills Experience:

HS Diploma Required Minimum of 2-year job-related experience National Association of Healthcare Access Management (NAHAM) certification within one year of hire Basic MS Word & MS Excel. Customer service and organizational skills. Associate's degree Preferred with 6 months job-related experience - Preferred.

Working Conditions:

• Manual: Little or no manual skills/motor coord & finger dexterity
• Occupational: Little or no potential for occupational risk
• Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Company: Health Quest Systems Inc
Org Unit: 1964
Department: Contact Center
Exempt: No
Salary Range: $18.13 - $26.00 Hourly

Available benefits include:

• Paid Time Off (PTO)
• Medical, Dental and Vision Coverage
• Health and Dependent Care Flexible Spending Accounts
• Health Savings Account
• 401(k) Retirement Plan
• Basic Life and AD&D insurance
• Wellness Programs
• Employee Assistance Program
• Team Member Discounts
• Available benefits for union positions may vary in accordance with applicable Collective Bargaining Agreements.