PreService Representative

USA Health Systems; Mobile (AL); On-site; USD 36,000 - 52,000; Full time

Job summary

USA Health is seeking a qualified Insurance Verification Specialist to support payment processes across Mobile facilities. The role emphasizes accuracy in verifying coverages and obtaining necessary precertifications to enable timely patient care.

Responsibilities include submitting authorizations, gathering documentation, and coordinating with payers, providers and patients. A high school diploma plus two years of insurance verification or precertification experience in medical settings is

Qualifications

• High school diploma or equivalent; two years of insurance verification and/or precertification experience in a medical office or hospital setting.

Responsibilities

• Follows compliance requirements and hospital policies in all duties.
• Obtains clinical and lab documentation from EMRs for payer submissions and authorizations.
• Submits authorization requests electronically via payer portals and coordinates with payers to avoid delays.
• Communicates with patients, departments and providers to keep them informed and to resolve access-to-care issues.

Skills

Insurance verification

Precertification

Compliance awareness

Education

High school diploma or equivalent

Job description

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Responsibilities

Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization’s values; adheres to hospital policies including confidentiality; requires minimal supervision to safely perform essential functions; utilizes proper body mechanics when moving equipment and supplies that are necessary to perform essential functions; reports broken or malfunctioning equipment to supervisor or manager; initiates requests, follows up to provide additionally required information, tracks progress, expedites responses from insurance carriers and other payers, and maintains contact with patients, departments and providers to keep them continuously informed; tracks, reports, and escalates service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt care of therapies; obtains clinical, lab and medical testing documentation from at least two EMR’s and from paper documentation for submission to payers; interacts with all necessary portals to submit authorization requests electronically to receive as timely of responses as possible, using websites and telephone services as needed; participates in regular group discussions regarding effectiveness of service by reviewing results, including any denials for reason under the purview of this position; participates in work-group discussions and on committees as assigned; participates in Performance Improvement activities as assigned; regular and prompt attendance; ability to work the schedule as defined and overtime as required; related duties as required.

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Additional Information

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Qualifications

High school diploma or equivalent and two years of insurance verification and/or precertification experience in a medical office or hospital setting.