Pre-Services Representative I - FT - Days - Hybrid eligible -MSS

memorialhealthcare; United States; On-site; USD 36,000 - 54,000; Full time

Job summary

Memorial Healthcare System in the United States is seeking an Insurance Verification/Authorization Clerk to verify coverage, coordinate benefits, and obtain pre-authorizations for services. You will discuss financial responsibilities with patients, schedule orders, and handle pre-service calls to ensure accurate billing and revenue estimates.

The role emphasizes accuracy, accountability, strong communication, and the ability to work with minimal supervision in a busy hospital environment.

Qualifications

• High School Diploma or Equivalent (Required).
• Experience with hospital authorizations and health insurance knowledge.
• Excellent communication, critical thinking, decisive judgment and the ability to work with minimal supervision.

Responsibilities

• Determines and verifies insurance coverage and coordination of benefits.
• 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 when applicable.
• Handles inbound and outbound calls related to pre-service functions.

Skills

Accountability

Accuracy

Customer service

Organization skills

Problem solving

Productivity

Responding to change

Standards of behavior

Education

High School Diploma or Equivalent

Job description

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.

Summary:

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

Responsibilities:

Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for that service(s). Documents authorization information within the patient account. Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs. 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. Document details of the call and notate any collections that need to be performed at time of registration. Handles inbound and/or outbound calls to perform all pre-service functions included but not limited to 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.

Competencies:

ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, ORGANIZATION SKILLS, PROBLEM SOLVING, PRODUCTIVITY, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

High School Diploma or Equivalent (Required)

Additional Job Information:

Complexity of Work: 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.

Required Work Experience:

No prior experience required.

Other Information:

Preferred experience with hospital authorizations and health insurance knowledge.

Working Conditions and Physical Requirements:

• Bending and Stooping = 0%
• Climbing = 0%
• Keyboard Entry = 80%
• Kneeling = 0%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 0%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 0%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 80%
• Distinguish Color = 0%
• Seeing - Far = 80%
• Seeing - Near = 80%
• Bio hazardous Waste = 0%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 0%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 0%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 0%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift:

Primarily for office workers - not eligible for shift differential

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer.

Memorial Healthcare System is proud to be an equal opportunity employer committed t