Pre-service Representative

+ POSITION SUMMARY+ Responsible for all aspects of scheduling of Inpatient and Outpatient procedures+ Knowledgeable of recording patients into lobbying system+ Responsible for the complete registration of a patient+ Knowledgeable of patient transfers and bed placements for all departments+ Will be held accountable for meeting the standard productivity rate of 94% to 105%.+ Must understand and comply with HIPPA+ Knowledgeable of Medicare and the questionnaire that must be completed on each Medicare patient+ Responsible for verifying insurance benefits and accurate entry of patient demographics and financial data.+ Will be responsible for fulfilling all PayNav functionalities including medical necessity on all Medicare patients, cost estimates for each patient and insurance verification on all patients.+ Strive to reach 100% of your personalized collection goal.+ Will be accountable for accuracy of information entered and documentation provided.+ Will be held accountable for meeting the standard accuracy rate of 98% or higher in AHIQA.+ Will coordinate referral of account to appropriate personnel, including Customer Service+ Responsible for maintaining, responding, and addressing all SGMC emails, phone calls, and voice messages.+ KNOWLEDGE, SKILLS & ABILITIES+ Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, Series, Trace, PayNav, and Microsoft Office applications.+ Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach Care; Tricare (Standard, Extra and Prime);VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Georgia Indigent Care Trust Fund; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.+ Strong verbal communication skills.

Excellent customer service skills.

Interacts with: patients; other departments; physician offices; other acute medical care providers; insurance companies; pre-certification companies; employers; intermediaries; utilization review companies; and state regulatory agencies (GMCF, Medicaid).+ Knowledge of, or coursework in, medical terminology.+ Familiarity with CPT Codes, HCPCS, and ICD-10, and PCI compliance.+ Related regulatory and legal requirements: Medicare Secondary Payer Questionnaire; Advance Directives (living wills, healthcare surrogate); medical necessity checking requirements; ABNs; letters of non-coverage; coordination of benefits.+ Reimbursement methodologies: percent-of charges; discounted fee-for-service; fee schedule; cost-based; capitation.+ Must have a thorough understanding and knowledge of patient type; financial class; insurance master; employer codes; clinic codes; physician coding; admission source codes; relationship codes; accommodation codes; special handling codes; medical service codes.+ College degree or coursework preferred.

CPAR preferred.+ Must be able to organize workload in an efficient manner and type 40 wpm accurately.+ Previous data entry, programming, office coordinator experience highly preferred.