PRE SERVICES SPECIALIST I
Company: Elliot Health System
Location: Manchester
Posted on: January 22, 2023
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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
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