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

Memorial Healthcare System
Any Location, FL
Category Customer Service
Job Description
Determines and verifies insurance coverage and coordination of insurance benefits from all sources. Requests and/or verifies authorizations for ordered services. Schedules and/or reschedules 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.

Requirements

  • 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
  • Documents 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
  • 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
  • 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)
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