What are the responsibilities and job description for the Sr. Pre-Services Representative position at Adventist Health?
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Acts as the subject matter expert for obtaining and verifying demographic, confidential clinical and financial information necessary to accurately and efficiently financially secure hospital procedures in a timely fashion. Pre-registers patients, verifies insurance eligibility and benefits, and identifies those services that require an insurance authorization, notification and/or recertification. Completes medical necessity review. Determines estimated financial responsibility and communicates to patients and collects payment. Adheres to all JCAHO, CMS, and HIPAA requirements when creating a hospital account. Assists with escalated encounters. May assist with associate training and education directed by leadership. Works directly with nurses, medical staff, ancillary departments, insurance carriers, and other external professionals to assist patients with obtaining healthcare and financial services. Assists and educates patients through the process to provide a positive patient experience.
Job Requirements:
Education and Work Experience:
- High School Education/GED or equivalent: Required
- Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
- Experience within registration, insurance verification and/or authorization initiation in a hospital setting: Preferred
- Customer service experience: Preferred
- Healthcare front office experience: Preferred
Essential Functions:
- Responsible for running a daily Panther report to obtain all provider’s signed notes each day and completes financial clearance activities for patients professional fee encounters in a timely manner.
- Obtains all necessary insurance eligibility, and demographic information from representatives and insurance web sites, as applicable. Obtains necessary authorization numbers for inpatient stays from physician offices.
- Works with clinic authorization staff to obtain outpatient authorization numbers and enters in correct location in the revenue cycle application. Completes accurate registration and financial clearance for professional fee encounters in a timely manner.
- Assists other team members with clinic non office encounter information and insurance issues as needed. Assist in the coverage for absent team members or with high volumes.
- Works return queues timely, with goal to have no returns in a queue for longer than 5 days. Strives to have as few returns as possible. Revews denial data and creates job aids to ensure the reduction of denials related to registration and financical clearance.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
