What are the responsibilities and job description for the Pre-Service Specialist position at Memorial Hospital, Carthage, IL?
Full-Time
Carthage, Illinois
Posted 1 day ago
19.00-$19.50/hour
Job Summary
The Pre-Service Specialist monitors compliance with Federal and State regulations in the process of pre-certifying all procedures and services. This specialist will communicate internally with leadership when encountering any pre-certification and/or billing issues. Additionally, this specialist will communicate externally with the patient to provide clear expectations of financial responsibility.
Primary Job Responsibilities
- Verifies all insurance on scheduled services and provides an estimate of the self pay portion to the patient.
- Obtains pre-authorizations/pre-certification per payer requirements for scheduled and non-scheduled hospital and clinic services prior to services rendered and ensures authorization number is documented in the appropriate field in the system.
- Ensures the clinical documentation is provided to the insurance when appropriate for all IP and OP services.
- Monitors the approval of all observation, inpatient, and swing bed patients for adequate approval of covered days. Call the insurance company when appropriate to request additional days.
- Inputs information for inpatient stays into the Medicaid IP Health Solution system for pre-certification approval.
- Completes referral documentation and forms for patients being referred from Memorial Medical Clinics to a specialist.
- Completed all United Healthcare referrals in the appropriate system.
- Monitors the daily operations of Financial Counseling for scheduled services.
- Reports all Financial Counseling, pre-authorization, pre-certification, and/or registration issues to the Director of Revenue Cycle.
- Maintains effective communications with physicians, physicians’ offices, ancillary departments, other departments, and co-workers as is appropriate.
- Helps to maintain a professional atmosphere for patients and clinical staff.
- Demonstrates the ability to properly prioritize activities within the department as needed.
- Assists the nursing staff by performing clerical duties for scheduled patients as needed.
- Demonstrates good leadership qualities by maintaining a proper perspective on the ability to fulfill every department’s needs at the same time.
- Works at establishing and maintaining a good rapport and professional working relationship with all departments within Memorial Hospital and all physicians’ clinics.
- Demonstrates the ability to communicate with the public in a courteous and informative manner; maintains strong verbal and written communication skills.
- Monitors activity related to Patient Financial Assistance, Precertification, and Pre collection.
- Remains current with reimbursement requirements and insurance requirements for Pre-Authorization.
- Obtains current basic knowledge of CPT and ICD-10 codes.
- Proficient in the understanding of Co-pays, deductibles, co-insurances, and other insurance verbiage.
- Routine contact with insurance companies, state agencies, collections agencies etc.
- Communicates effectively with a wide range of age groups from the very young to the elderly and multiple socio-economic backgrounds.
- Perform other duties as assigned or requested.
Required Qualifications
- High school graduate or equivalent.
- Extensive knowledge of CPT codes and ICD-10 codes.
- Proficiency with all Microsoft programs including Word, Excel, and Outlook.
- Basic accounting principles.
- Extensive knowledge of computer related skills.
- Mathematical skills and typing (30 wpm) skills.
- Clear, legible handwriting skills.
- Proficiency in the use of an electronic 10-key calculator, fax machine, copy machine and accurately perform filing functions.
Preferred Qualifications
- CPAT, RMA, CHAA certification or experience equivalent
- 6 months or more of previous experience in a hospital Patient Financial Services Department
- Experience with managed care contract terms
- Medical terminology knowledge
- 2-3 years of customer service experience
Location: Memorial Hospital – Carthage
Status: Full time (32 hours/week)
Wage Range: $19.00/hour-$19.50/hour
(Actual wage based on relevant experience)
Pertinent Skills Required
- Must be able to work well with people of all ages and nationalities.
- Good human relations, written and oral communication skills.
- Sound judgment and problem-solving skills are necessary.
- Ability to distinguish difference between numbers and/or names that are similar, good filing skills.
- Ability to prioritize and perform multiple tasks with many interruptions.
- Requires manual dexterity for the operation of a keyboard and mouse.
- Hearing must be within range of normal human conversation.
- Specific vision abilities by this job include the ability to adjust focus.
- Subject to many interruptions, variable, and unpredictable and/or stressful situations.
- Clear, legible handwriting skills.
Physical And Environmental Demands
- Ability to lift, carry, push, pull, or otherwise move objects up to 50 pounds in weight.
- Capable of moving files and performing filing functions, i.e., reaching, stooping, bending, kneeling, crouching, crawling.
- Frequent prolonged periods of sitting or standing.
- Ability to verbally communicate with customers and co-workers.
- Ability to walk, bend, and stand as needed.
- Potential exposure to infectious and contagious diseases, blood and/or bodily fluids.
- Subject to rotating weekend/holiday schedules.
- Occasionally subject to irregular hours.
Job Features
Job Category
Health Information Management
Price Range
19.00-$19.50/hour
Salary : $19 - $20