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

Memorial Healthcare System; Town of Florida (NY); On-site; USD 42,000 - 65,000; Full time

Job summary

Memorial Healthcare System is seeking a detail-oriented Insurance Verification Specialist to determine and verify coverage, request authorizations, and coordinate billing for outpatient services. This role involves discussing financial responsibilities with patients and guarantors, collecting upfront payments, and reviewing insurance benefits for accuracy.

Responsibilities include scheduling and rescheduling physician orders, communicating with patients and practitioners about insurance matters,

Qualifications

• High School diploma or equivalent is required.
• Experience with hospital authorizations preferred.
• Knowledge of health insurance processes is a plus.

Responsibilities

• Handles inbound and outbound calls to manage scheduling, authorizations, benefits, and patient responsibilities.
• Documents call details and disposition in the patient account.
• Inputs and reviews patient insurance information to ensure correct billing and net revenue estimation.
• Communicates with patients and practitioners regarding orders, insurance and authorization issues.
• Notifies guarantors of out-of-pocket responsibilities and collects pre-service payments.
• Ensures compliance with departmental payment procedures.

Skills

Insurance verification

Authorization handling

Customer service

Communication skills

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

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. Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs. Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for that service(s). Documents authorization information within the patient account. 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.

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

Disclaimer

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. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [e-mail]