PRE SERVICES SPECIALIST I

Company: Elliot Health System
Location: Manchester
Posted on: January 22, 2023

Job Description:

POSITION SUMMARYTo provide superior service excellence and promote the Elliot Experience to all who access the Elliot Health System. Pre-Services Specialists are members of the Patient Access team dedicated to completing patient access workflows related to scheduled patient services for the inpatient, ambulatory, and physician practice settings. Pre-Services Specialists work directly with referring physician offices, payers, and patients to ensure full financial clearance prior to the provision of care.PRIMARY DUTIES AND RESPONSIBILITIESEmployees are expected to work consistently to demonstrate the mission, vision, beliefs, core values and standards of behavior of the organization. Follows established department policies to completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the EHS enterprise.Establishes contact with patients via inbound and outbound calls and accesses department Pre-Registration work queues to pre-register patients for future dates of service.Verifies insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers documents payer verification responses in designated fields within the registration pathway. Compares the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contacts the patient and provides guidance for resolution of PCP discrepancies or mismatches. Validates insurance referral status, if applicable, and communicates with PCP office to obtain referrals.Validates pre-certification status, if applicable, and communicates with ordering physicians' offices to obtain pre-certification information; documents pre-certification status in designated field within the registration pathway. Provides notification of admission to payers within 24 hours of admission for inpatient stays.Initiates and completes the Medicare Secondary Payer Questionnaire (MSPQ) via a phone interview with the patient as necessary.Interprets insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.Communicates patient financial responsibility amounts and initiates the point of service (POS) collections process.Identifies patients requiring payment assistance options and facilitates communication between patients and EHS Financial Counselors.Works collaboratively with all departments/services of the Elliot Health System to ensure that all scheduled patients have undergone financial clearance prior to service.Receives and directs incoming calls for inpatient and outpatient services.Schedules and coordinates physician, patient, department and hospital resources to assure prompt patient services.Keeps informed of department needs and coordinates schedules to meet test and procedure requirements.Provides pre-test instructions to patients for selected tests/procedures to ensure that patients are appropriately prepared for testing.Promotes utilization of off-site facilities by educating patients as to services provided and location.POSITION QUALIFICATIONSEducation:Minimally Required:High school diploma or equivalent requiredExperience:Preferred:A minimum of one (1) year healthcare experience in Patient Access registration, pre-registration, or insurance verification or equivalent office / customer service experience preferred.Computer, telephone, fax machine. EPIC experience preferredKnowledge:Minimally Required:Knowledge of and compliance with confidentiality guidelines and EHS policies and procedures.Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers.Knowledge of and compliance with regulatory guidelines, such as EMTALA, HIPAA, MSPQ, ABN, and Red Flag.Skills:Minimally Required:Superior customer service skills and professional etiquette.Strong written and oral communication skillsAbilities: Minimally Required: Attention to detail and ability to multi-task in complex situations.Demonstrated ability to solve problems independently or as part of a team

Keywords: Elliot Health System, Manchester , PRE SERVICES SPECIALIST I, Other , Manchester, New Hampshire