Hotline: 678-408-1354

The Pre-Service Specialist is responsible for scheduling patients for services at Saint Alphonsus Health System (SAHS) facilities; performing insurance verification to determine benefits and patient liability; notifying patients of their appointments and financial obligations for their scheduled services; and ensuring appropriate financial counseling and payment options have been presented to the patient prior to services being rendered. Deliver exceptional quality and service to all patients and other customers through a constant pursuit of excellence and respect for every individual. Foster an environment of participation, teamwork, and professional growth. Collaborate with multiple departments to best utilize equipment, staff and other resources while accommodating physician preference and patient needs, consistent with Saint Alphonsus Health System’s values and missions.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

  • High School Diploma or equivalent required.
  • Type 45 WPM.
  • Previous experience in hospital or medical field preferred.
  • Demonstrated ability to efficiently organize work and maintain a high level of accuracy and productivity.
  • Fosters and creates a cooperative teamwork environment.
  • Demonstrates excellent professional interaction skills with patients and staff.
  • Demonstrated independent problem solving and decision making abilities and has the ability to use critical thinking skills.
  • Exceptional computer skills including Excel, Outlook and Word.
  • Demonstrates knowledge of insurance, ICD9 and CPT coding.
  • Excellent customer service skills necessary to interact with patient/physicians to maintain and promote positive relationships.
  • Ability to work with a wide variety of people under adverse conditions.
  • Demonstrates verbal and written communication skills to portray a professional image.

ESSENTIAL FUNCTIONS:

  • Meets system’s Guiding Behaviors and Caring including interpersonal communication and professional conduct expectations.
  • Maintain confidentiality of all patients according to Health Information Portability and Accountability Act (HIPAA) standards.
  • Performs scheduling, financial clearance, document imaging and other required department activities according to department standards.
  • Secures and verifies demographic, employment, payer, and other required information to establish and/or update a patient’s records.
  • Obtain insurance benefits on all insurance types. Accurately documents patient accounts with insurance information.
  • Provides information and assistance, answers incoming telephone calls, schedules appointments and relays verbal and written messages to physicians and staff.
  • Inform patient/physician offices of preparations for procedures scheduled, verbally and/or by printed itinerary.
  • Collaborate with designated departmental clinical contracts to facilitate add-on/emergent procedures, guidance for any questionable or unusual request, and interactions necessary to resolve resource conflicts that may necessitate scheduling changes or authorization to override schedule.
  • Obtains information necessary to complete scheduled service; including medical necessity checking, insurance authorization, referral, and valid order according to department policy.
  • Performs verification of insurance to include verifying all required pre-authorizations and / or referrals are obtained for services and assisting with payment arrangements.
  • Identifies accounts with minimal or no insurance coverage and refer accounts to Financial Counselor.
  • Ensures that the ABN process is completed in compliance with Medicare regulations.
  • Works all patient accounts needing authorization for services to eliminate SAHS liability for non-covered service days. Initiates pre-cert notifications either electronically or by phone. Faxes reports to the appropriate insurance companies for continued review of services.
  • Ensure that accounts are accurate and complete, including demographic and insurance information, prior to the generation of a patient bill.
  • Communicates with Case Management (CRM) staff to facilitate the identification of accounts needing review for authorized days.
  • Processes daily department reports to maintain department insurance verification standards.
  • Exhibit proficiency in document imaging: scanning and attaching necessary documents to patient accounts to assure the ability to collect authorization, clinical information, and payment for all services provided. Use scanners, auto fax, and document imaging features proficiently.
  • Utilize and keep a current working knowledge of all reference materials and information used in the department.
  • Appropriately prioritizes workload and maintains productivity standards.
  • Foster a team environment by involving Continuous Quality improvement. Promote teamwork by keeping others informed; exhibiting effective group decision-making participation while working to accomplish team objectives and projects. Seeks feedback about ones’ effectiveness as a team member.
  • Meets the system’s Customer Services Standards including interpersonal communication and professional conduct expectations.
  • Works department reports and does timely entry of department benchmarking metrics as defined by supervisor.

Job Type: Full-time

Experience:

  • hospital: 1 year (Preferred)
  • Medical Terminology: 1 year (Preferred)

Education:

  • High school (Required)

Contact Us

Eltas EnterPrises Inc.
3978 Windgrove Crossing
Suite 200A
Suwanee, Georgia
30024, USA
contact@eltasjobs.com

Subscribe to our Newsletter