The Pre Service Center Associate is responsible for the financial clearance prior to the scheduling of patients for procedures, studies, admissions and infusions. Responsibilities include verifying patient demographic information, proper insurance verification, securing service authorizations, initiating any number of available financial assistance programs and registering patient accounts for charges, as well as discussing out of pocket expectations with the patients and how that will be collected. This is a dynamic role with significant responsibility, requiring different types of skill sets that include a positive and patient-focused attitude, demonstrating patience and understanding in a high pressure, high volume environment and exceptional communication and follow up skills.
Verify insurance eligibility, benefits, and medical necessity prior to scheduling procedures, studies, infusions and admissions.
Obtain prior authorization as required by private insurance and governmental payers.
Make referrals for financial counseling to ensure patients are aware of their insurance coverage and financial responsibility or payment options.
Maintains close relationships with ordering providers office to clear patients for their scheduled services. Understands and communicates delays in obtaining prior authorizations and effectively communicates to the ordering provider.
Register patient accounts in all systems; compile complete and accurate information for EMR records and timely reimbursement.
Responds to the coding and billing department, UR, pharmacy, registration, and provider office inquiries effectively to questions and concerns expressed by patients and/or providers and staff.
Monitors schedules for add on and emergent procedures requiring authorization and obtains.
Ensure scheduled service conforms to established authorizations.
Resolve problems (registration, eligibility, billing or financial) in a timely manner.
Working knowledge of coding, billing, insurance coverage, medical terminology, insurance reimbursement and medical records.
Excellent interpersonal skills.
Good verbal and written skills.
Able to handle confidential patient and organizational information.
Strong technology and computer literacy skills.
Experience working with databases, electronic medical records and other systems.
Ability to assist clinicians with coding and reimbursement questions related to prior authorizations and coverage.
Minimum five (5) years' experience in a medical setting.
Parkview Adventist Medical Center