Preadmissions Specialist

Avera Health

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$19.25 - $25.00

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible for ensuring insurance eligibility, benefit verification and authorization processes are complete in the time allowed by the insurance companies (payor) to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payor and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements and resources to facilitate appropriate insurance verification and authorization. Specialists must be able to understand and interpret patient liability and benefits for all payor types including copays, co-insurance and out-of-pocket responsibilities in order to provide patients with information on their financial responsibility. The Specialists are to conduct all transactions appropriately and consistently and complete government regulatory forms accurately with the patient. Specialists must maintain compliance with government regulations (i.e. HIPAA) as it pertains to the insurance process. The Pre-Admissions Specialist is responsible for answering Centralized Scheduling phones, accepting outpatient diagnostic orders from physicians for hospital departments: interpreting physician request/s for diagnostic test/s and scheduling single to multiple tests according to required patient care protocols. The Specialist will determine medical necessity validation and handle medical information. The aforementioned tasks may be completed on site. Scheduling skillset should include ambulatory scheduling workflow.

What you will do

• Process eligibility and secure full benefit coverage information with payors, confirm all demographic information and ensure coordination of benefit (COB) and insurance plan codes are accurate.
• Complete original authorizations, as required, using payor portals or phone calls and using medical records, when necessary, to support prior authorization requests.
• Obtain necessary paper/electronic referrals, authorizations and precertification from Primary Care Physician and/or Specialty Physician when required by payors, Managed Care and traditional Medicaid.
• Complete hospital pre-registration, either in person or via phone call, prior to the patient's arrival for service.
• Collect and validate accurate patient demographic and payor information, verify insurance and obtain precertification authorization as required.
• Schedule and coordinate patient appointments for labs, radiology procedures and advanced imaging procedures through the CWS module and surgical procedures through the SUR module as requested and according to established guidelines, maintaining the highest level of efficiency.
• Facilitate coordination of a plan of care for patients with various departments throughout the hospital.
• Obtain information, such as physician orders and H&Ps, from physician offices for scheduling tests and procedures in an accurate, timely and sequential manner.
• Ensure medical necessity by reviewing the physician orders and diagnosis; assure follow up for physician office and patients as necessary.
• Support the Manager in maintaining all Meditech modules by suggesting upgrades, monitoring data integrity and maintaining accurate instructions/dictionaries.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Associate's in finance, business or healthcare from an accredited university/college
• 4-6 years hospital, medical office, clinic or hospital business operations experience

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO front-loaded for eligible hires

• Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org .