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

memorialhealthcare; Murfreesboro (TN); On-site; USD 22,000 - 34,000; Full time

Job summary

Memorial Healthcare is seeking a dedicated Pre-Services Specialist to verify insurance benefits, coordinate authorizations, and discuss financial responsibilities with patients and guarantors. You will schedule and reschedule physician orders for outpatient services and collect upfront payments as needed.

Ideal candidates have a high school diploma and strong communication, accuracy, and organizational skills to work in a busy revenue cycle environment.

Qualifications

• Experience supporting revenue cycle or patient access functions preferred.
• Strong communication and critical thinking abilities.
• Comfort with calculating patient liabilities and benefits.

Responsibilities

• Handle inbound and outbound calls to perform pre-service functions including scheduling, authorizations, benefits, and patient responsibilities.
• Document call details and disposition.
• Input and review insurance benefits for patient accounts.
• Re-run estimates to correct patient out-of-pocket liability.
• Coordinate training and quality assurance for staff.
• Educate guarantor about out-of-pocket responsibility and collect pre-service payments.
• Ensure compliance with payment procedures.
• Notify patients of financial responsibility for services.

Skills

Customer service

Accuracy

Accountability

Organization skills

Problem solving

Productivity

Communication

Education

High School Diploma or Equivalent

Job description

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.
• Input and/or review insurance benefits for the patient account.
• Re-run estimates when needed to correct expected patient out of pocket liability for that service.
• Perform job duties outside of Pre-Services within the Revenue Cycle areas.
• Updates patient insurance information into the patient record as needed to ensure correct billing and net revenue estimation occurs.
• Facilitates the coordination of training and/or quality assurance of new and current employees.
• Develops and mentors staff to align with departmental goals as well as acts as a resource for internal/external departments.
• Confirms insurance coverage.
• Determines necessity for pre-authorization and obtains authorization for that service(s).
• Documents authorization information within the patient account.
• Communicates with patients and practitioners regarding order, insurance and/or authorization issues.
• Reviews order for appropriate authorizing signature and accuracy of scheduled service(s).
• Notifies patient of their financial responsibility for services to be provided.
• Educate 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.

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