What are the responsibilities and job description for the Pre Service Specialist position at Advocate Aurora Health?
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Contacts the patient to obtain/validate demographics and insurance information. Completes insurance verification and eligibility checks and documents patient liability.
- Collects and accurately documents initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
- Calculates patient liabilities based on scheduled procedures and previous balances. Informs the patient of his/her liability and discusses financial obligations with the patient including requesting payment.
- Communicates to physician office/patient the organization expectation of payment and/or having an authorization on file prior to service, explaining service may be re-scheduled.
- Schedule patient visits using guidelines established within scheduling system. Recognizes exceptional scheduling situations and escalates as necessary. Completes necessary online EPIC questionnaires needed to complete scheduled exam.
- Provides accurate, detailed information regarding test preparations, time of patient arrival and any other directional information.
- Works assigned EPIC Scheduled Order Work Queue, following the department’s work flow process on appropriately transferring, deferring or removing orders from the work queue.
- Proactively communicates issues involving customer service and process improvement opportunities to management.
- Maintains excellent public relations with patients, families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
- Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- High School Graduate.
Experience Required:
- Typically requires 1 year of experience in health care, insurance industry, call center or customer service setting.
Knowledge, Skills & Abilities Required:
- Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
- Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
- Mathematical aptitude, effective communication skills and critical thinking skills.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
- Ability to speak effectively to customers or employees of organization, maintaining a pleasant, professional demeanor.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
- Demonstrated technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Physical Requirements and Working Conditions:
- Must be able to sit the majority of the workday.
- Occasionally lifts up to 10 lbs.
- Exposed to a normal office environment.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
