Pre Access Rep

Pre Access Rep

Requirements

• HS diploma or equivalent
• 2-3 years related experience, preferably in a healthcare setting (revenue cycle experience preferred), hospital, physician office or insurance company
• Basic knowledge of medical terminology

Responsibilities

• Collects, analyzes and records accurate and compliant demographic and clinical information in the scheduling system
• Positively identifies the patient before accessing existing medical record numbers or creating new patient entries
• Provides patients with site and appointment date and time options, scheduling per patient preference or first appointment at optimal site
• Accurately enters all required patient demographic and clinical data in scheduling application
• Checks receipt of faxed orders and reviews for accuracy
• Schedules with proper test sequencing when multiple tests are ordered
• Engages in frequent communication with all departments to ensure scheduling openings are current
• Explains procedures and provides patients/customers with accurate preparation information prior to exam
• Provides directions for patients to follow on day of service
• Maintains synchronicity between the scheduling and registration systems when rescheduling, canceling or editing accounts
• Identifies and responds appropriately to callers’ communication needs
• Accurately collects, records and analyzes all required demographic, insurance/financial and clinical data necessary to preregister/preadmit patients
• Scans (or ensures) printed orders into the patient’s account
• Completes the MSP (Medicare Secondary Payer Questionnaire) thoroughly
• Performs an abbreviated screening of insurance benefits
• Records accounts notes and appropriately codes accounts for hand-off to financial clearance
• Reviews physician orders and other documentation against Medicare payer coverage and medical necessity criteria
• Identifies if authorization/prior approvals are required for scheduled services
• Schedules patients without authorization at least three days out
• Pre-authorizes patient for services with insurance company
• Collects and records accurate and thorough patient, guarantor, insured and insurance information when preregistering patient accounts
• Pre-registers accounts using appropriate clinic and service codes
• Performs revenue cycle activities that prevent payment denials
• Verifies insurance eligibility and obtains benefit information and service authorizations
• Follows up any accident, injury, or third party liability diagnosis appropriately
• Reviews the pass/fail of Medicare patients’ outpatient testing
• Identifies payment obstacles for Medicaid patients
• Communicates with appropriate persons regarding all aspects of pre-registration, registration, verification, precertification and date of service / insurance issues
• Alerts Financial Counselors when presented with out of network plans
• Enters thorough account notes in system
• Enters verification flag in system as applicable
• Contacts the patient/representative, physician, insurance company or others if additional information is needed
• Places reminder calls to pre-registered patients 24-48 hours prior to service date
• Reviews reports to determine who needs reminder calls
• Confirms service date/time/place with patients and reschedule services as needed
• Informs callers of insurance company findings
• Provides patients with information about their arrival and service area needs
• Reviews accounts for completeness and accuracy
• Indexes and names faxes located in fax storage system
• Accepts and completes other duties and special projects as assigned
• Performs other duties as assigned

Preferred Qualifications

No preferred qualifications provided.