The Pre-Services Specialist plays a vital role in providing an exceptional patient experience as well as in securing financial benefits for both the patient and FHLC alike. This position is responsible for patient financial screening, insurance verification, enrolling patients in Medicaid as applicable, securing prior authorizations, providing accurate patient expense estimates, and pre-service collections. The Pre-Services Specialist serves as a contact for patients to ensure open, professional, timely, courteous, and accurate communication occurs to secure the patient account prior to their visit.
Essential Duties and Responsibilities
- Responsible for reviewing provider schedules to identify self-pay patients, verify patient insurance, complete prior authorizations, and connect patient to the Patient Services Navigators to secure the patient account prior to the patient’s appointment.
- Connects with patients via in person and/ or by telephone prior to their scheduled services to complete pre-registration, insurance coverage verification, provide fee estimates, discuss resolution of financial obligations (including prior balances), collect any payments upfront, to financially secure patient account.
- Responsible for working patient authorization referrals in Epic OCHIN work queues and collaborates with other departments to complete insurance verification and fee estimates on patient accounts.
- Communicate with staff and patients as needed to notify of insurance authorization issues/ delays prior to receiving services and reschedule/ cancel if services not authorized
- Maintains authorization on file as needed going forward for additional services.
- Follows up on patient prior authorizations to ensure they are completed timely and accurately prior to the patient appointment.
- Initiate appropriate forms for workers comp, disability, etc. as applicable and pass on the appropriate clinical providers to complete to ensure patients can receive their benefits in a timely manner.
- Ability to analyze and interpret insurance benefits and Medicaid enrollment procedures.
- Handles all patient/family contact in a courteous, professional manner and consistently interacts with sensitivity to patients/their families and is responsive to individual needs.
- Ability to work collaboratively in a team-based approach with clinical and non-clinical staff, patients, and patient’s families.
- Provides an active voice in team meetings for the purpose of improving services to patients and maximizing patient benefits.
- Demonstrates ability to interact professionally in a variety of patient situations and adjust accordingly depending on the situation presented at time of service.
- Must adhere to FHLC policies and procedures.
- Regular and Reliable Attendance
- Performs other duties as assigned.
To perform this job successfully, the individual must be able to perform each essential duty satisfactorily. This position requires the individual to work independently, as well as in a group setting; Must be able to work under pressure and deal with stressful situations; is analytical and has excellent critical thinking and problem-solving skills; must always maintain patient confidentiality; must be able to establish and maintain effective working relationships with patients, employees, other departments, and external partners.
- Work may require sitting or standing for long periods of time; also stooping, bending, and stretching.
- Occasionally lifting files or paper weighing 25 pounds or more.
- Requires manual dexterity sufficient to operate a keyboard, telephone, copier, and other such equipment.
- Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.
- Work is performed in a medical office setting.
- Interactions with others are frequent and interruptive. Work may be stressful at times.
- Work schedules may be changed to accommodate departmental/facility needs
- The noise level in the work environment is moderately quiet.
- High School Diploma or equivalent required. Prior experience working in health care setting with knowledge of financial clearance including insurance verification, prior authorization, denials prevention and securing patient accounts preferred.
- Experience with Medicaid enrollment preferred.
- Keyboarding and computer skills, as well as familiarity with MS Office applications and Epic desired.
- Excellent customer service skills required.
- Understanding and working familiarity with rules and regulations of Federal, State and commercial payer requirements, particularly in FQHC programs.
- CPR certification required within six months of hire.
- English required. Bilingual (English/Spanish) language desirable. Ability to read & interpret documents, reports & correspondence. Ability to speak effectively before groups and/or individuals.
Family Health La Clinica is proud to be an Equal Opportunity Affirmative Action employer.
Family Health La Clinica(FHLC) requires employees to be vaccinated against COVID-19, or hold a legally recognized exemption as a condition of employment. Where permitted by law, candidates who are offered a position will be asked about their vaccination status, which must meet minimum business requirements. All religious, medical, or other legally recognized exemptions regarding vaccination status will be considered.