PreService Representative

USA Health; Mobile (AL); On-site; USD 34,000 - 51,000; Full time

Job summary

USA Health is seeking a detail‑oriented professional to verify insurance benefits and obtain precertifications for patients in a medical office setting.

Responsibilities include gathering documentation from EMRs and paper records, coordinating with payers, and communicating with patients and providers to ensure timely approvals and smooth case processing.

Qualifications

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

Responsibilities

• Process authorizations and referrals with health plans and payers to obtain timely approvals.
• Obtain clinical, lab and medical testing documentation from EMRs and paper records for submission to payers.
• Communicate with patients, departments and providers to keep them informed and expedite requests.
• Monitor and escalate service issues related to authorizations or financial assistance to avoid delays in patient care.

Skills

Insurance verification

Precertification

Medical office experience

EMR systems

Education

High school diploma

Tools

EMR systems

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.

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.

Equal Employment Opportunity/Affirmative Action Employer

The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis.

EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.