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

memorialhealthcare; United States; On-site; USD 36,000 - 48,000; Full time

Job summary

Memorial Healthcare System is seeking a detail-oriented Insurance Verification Coordinator to determine and verify insurance coverage for patients. You will coordinate authorizations, schedule pre-service procedures, and explain financial responsibilities to patients and guarantors.

The role requires strong communication, accuracy, and the ability to navigate complex payer rules. Experience with hospital authorizations and health insurance knowledge is preferred, with a high school diploma or

Qualifications

• High School Diploma or Equivalent is required.
• Preferred experience with hospital authorizations and health insurance knowledge.
• Excellent communication and critical thinking skills.

Responsibilities

• Determines and verifies patient insurance coverage and benefits.
• Requests and verifies authorizations for services.
• Schedules and/or reschedules physician orders for outpatient treatments and diagnostics.
• Discusses financial responsibilities for upcoming appointments with patient and/or guarantor.
• Collects upfront payments and reviews for financial assistance.
• Handles inbound/outbound calls related to pre-service functions and authorizations.
• Documents call details and dispositions in the patient record.

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

• 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.
• 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.

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

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.

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